{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T22:42:16Z","timestamp":1783809736567,"version":"3.55.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T00:00:00Z","timestamp":1516665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["T32DK007732-20"],"award-info":[{"award-number":["T32DK007732-20"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["7K23HL135273-02"],"award-info":[{"award-number":["7K23HL135273-02"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["M01 RR-00080"],"award-info":[{"award-number":["M01 RR-00080"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["M01 RR-00071"],"award-info":[{"award-number":["M01 RR-00071"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["M0100032"],"award-info":[{"award-number":["M0100032"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P20-RR11145"],"award-info":[{"award-number":["P20-RR11145"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["M01 RR00827"],"award-info":[{"award-number":["M01 RR00827"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["M01 RR00052"],"award-info":[{"award-number":["M01 RR00052"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["2P20 RR11104"],"award-info":[{"award-number":["2P20 RR11104"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["RR029887"],"award-info":[{"award-number":["RR029887"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DK 2818-02"],"award-info":[{"award-number":["DK 2818-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Multiple definitions are used to characterize orthostatic hypotension (OH), but the degree to which these definitions correspond with orthostatic symptoms is unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We analyzed data from African American Study of Kidney Disease and Hypertension (AASK), a randomized trial of African Americans with hypertension and kidney disease, to characterize the relationship between OH definitions and self-reported syncope, dizziness, or light-headedness. Orthostatic changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), or heart rate (HR) were determined each visit after standing 2:45 minutes. OH was defined using the consensus definition (a drop in SBP \u226520 mm Hg or DBP \u226510 mm Hg) or an often used clinical substitute based on HR (an increase \u226520 bpm).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among 1,094 participants (mean age 54.5 \u00b1 10.7 years, 38.9% female), there were 52,636 visits (mean 48\/person). Mean resting SBP, DBP, and HR at baseline were 147.7 \u00b1 22.3 mm Hg, 92.2 \u00b1 13.4 mm Hg, and 71.1 \u00b1 11.7 bpm, respectively. While the OH consensus definition was associated with syncope (odds ratio 2.49; 95% confidence interval: 1.13, 5.51), dizziness (1.89; 1.53, 2.33), and light-headedness (1.84; 1.52, 2.23), the clinical HR definition was only associated with dizziness (1.28; 1.07, 1.52). None of the OH components (SBP, DBP, or HR) reflected a natural threshold in the prevalence of symptoms; definitions using each of the 3 components were highly specific (\u226596%) with low sensitivity (1\u20135%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>While the consensus definition was more strongly associated with symptoms, OH definitions did not reflect natural thresholds in symptoms and were insensitive. This implies that the absence of OH using either consensus or clinical definitions does not exclude orthostatic symptoms, which has implications for evaluating clinical events like falls.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CLINICAL TRIALS REGISTRATION<\/jats:title>\n                  <jats:p>Trial Number: NCT01206062 (clinicaltrials.gov).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajh\/hpy010","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:17:32Z","timestamp":1516234652000},"page":"665-671","source":"Crossref","is-referenced-by-count":18,"title":["Orthostatic Hypotension and Symptoms in the AASK Trial"],"prefix":"10.1093","volume":"31","author":[{"given":"Stephen P","family":"Juraschek","sequence":"first","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Edgar R","family":"Miller","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence J","family":"Appel","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,1,23]]},"reference":[{"key":"2024012317003242300_CIT0001","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/ajh\/hpw108","article-title":"Orthostatic hypotension in middle-age and risk of falls","volume":"30","author":"Juraschek","year":"2017","journal-title":"Am J Hypertens"},{"key":"2024012317003242300_CIT0002","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1161\/01.HYP.19.6.508","article-title":"Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group","volume":"19","author":"Rutan","year":"1992","journal-title":"Hypertension"},{"key":"2024012317003242300_CIT0003","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/HYPERTENSIONAHA.110.161844","article-title":"Postural changes in blood pressure and incidence of ischemic stroke subtypes: the ARIC study","volume":"57","author":"Yatsuya","year":"2011","journal-title":"Hypertension"},{"key":"2024012317003242300_CIT0004","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/eurheartj\/ehp329","article-title":"Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project)","volume":"31","author":"Fedorowski","year":"2010","journal-title":"Eur Heart J"},{"key":"2024012317003242300_CIT0005","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1038\/jhh.2014.130","article-title":"Orthostatic hypotension in a cohort of hypertensive patients referring to a hypertension clinic","volume":"29","author":"Di Stefano","year":"2015","journal-title":"J Hum Hypertens"},{"key":"2024012317003242300_CIT0006","article-title":"Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit","author":"Press","year":"2015","journal-title":"J Hypertens"},{"key":"2024012317003242300_CIT0007","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/BF02291236","article-title":"Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy","volume":"6","author":"Kaufmann","year":"1996","journal-title":"Clin Auton Res"},{"key":"2024012317003242300_CIT0008","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10286-011-0119-5","article-title":"Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome","volume":"21","author":"Freeman","year":"2011","journal-title":"Clin Auton Res"},{"key":"2024012317003242300_CIT0009","volume-title":"Clinical Practice Guideline: Orthostatic Vital Signs","author":"Emergency Nurses Association","year":"2015"},{"key":"2024012317003242300_CIT0010","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0196-0644(87)80356-6","article-title":"Evaluation of the \u201ctilt test\u201d in children","volume":"16","author":"Fuchs","year":"1987","journal-title":"Ann Emerg Med"},{"key":"2024012317003242300_CIT0011","doi-asserted-by":"crossref","first-page":"197","DOI":"10.7326\/0003-4819-157-3-201208070-00462","article-title":"Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement","volume":"157","author":"Moyer","year":"2012","journal-title":"Ann Intern Med"},{"key":"2024012317003242300_CIT0012","volume-title":"Hypertension in adults: diagnosis and management | Guidance and guidelines | NICE"},{"key":"2024012317003242300_CIT0013","first-page":"527","article-title":"Evaluation and management of orthostatic hypotension","volume":"84","author":"Lanier","year":"2011","journal-title":"Am Fam Physician"},{"key":"2024012317003242300_CIT0014","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1056\/NEJMoa0910975","article-title":"Intensive blood-pressure control in hypertensive chronic kidney disease","volume":"363","author":"Appel","year":"2010","journal-title":"N Engl J Med"},{"key":"2024012317003242300_CIT0015","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1038\/ki.1997.29","article-title":"Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: a report from the African American Study of Kidney Disease (AASK) Trial. AASK Pilot Study Investigators","volume":"51","author":"Fogo","year":"1997","journal-title":"Kidney Int"},{"key":"2024012317003242300_CIT0016","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1097\/HJH.0000000000001215","article-title":"Hospital admissions for orthostatic hypotension and syncope in later life: insights from the Malm\u00f6 Preventive Project","volume":"35","author":"Ricci","year":"2017","journal-title":"J Hypertens"},{"key":"2024012317003242300_CIT0017","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/0002-9343(91)90012-M","article-title":"Syncope and orthostatic hypotension","volume":"91","author":"Atkins","year":"1991","journal-title":"Am J Med"},{"key":"2024012317003242300_CIT0018","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10286-011-0146-2","article-title":"The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale","volume":"22","author":"Kaufmann","year":"2012","journal-title":"Clin Auton Res"},{"key":"2024012317003242300_CIT0019","doi-asserted-by":"crossref","first-page":"6127340","DOI":"10.1155\/2016\/6127340","article-title":"Cerebral blood flow, heart rate, and blood pressure patterns during the tilt test in common orthostatic syndromes","volume":"2016","author":"Novak","year":"2016","journal-title":"Neurosci J"},{"key":"2024012317003242300_CIT0020","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1161\/01.STR.29.9.1876","article-title":"Hypocapnia and cerebral hypoperfusion in orthostatic intolerance","volume":"29","author":"Novak","year":"1998","journal-title":"Stroke"},{"key":"2024012317003242300_CIT0021","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0735-1097(02)01923-X","article-title":"U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor","volume":"40","author":"Kario","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2024012317003242300_CIT0022","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1001\/jamainternmed.2017.2923","article-title":"Early orthostatic hypotension and orthostatic intolerance-more than an observation or annoyance","volume":"177","author":"Singer","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2024012317003242300_CIT0023","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1532-5415.2011.03317.x","article-title":"Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study","volume":"59","author":"Gangavati","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"2024012317003242300_CIT0024","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1001\/jamainternmed.2017.2937","article-title":"Association of history of dizziness and long-term adverse outcomes with arly vs later orthostatic hypotension assessment times in middle-aged adults","volume":"177","author":"Juraschek","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2024012317003242300_CIT0025","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/S0196-0644(05)82376-5","article-title":"Orthostatic vital signs in emergency department patients","volume":"20","author":"Koziol-McLain","year":"1991","journal-title":"Ann Emerg Med"},{"key":"2024012317003242300_CIT0026","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/qjmed\/hcp020","article-title":"Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension","volume":"102","author":"Cooke","year":"2009","journal-title":"QJM"},{"key":"2024012317003242300_CIT0027","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S1525-8610(04)70128-0","article-title":"The degree and timing of orthostatic blood pressure changes in relation to falls in nursing home residents","volume":"5","author":"Maurer","year":"2004","journal-title":"J Am Med Dir Assoc"},{"key":"2024012317003242300_CIT0028","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1097\/HJH.0b013e328331a810","article-title":"Orthostatic hypotension: revision of the definition is needed","volume":"27","author":"Braam","year":"2009","journal-title":"J Hypertens"},{"key":"2024012317003242300_CIT0029","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1532-5415.2011.03352.x","article-title":"Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people","volume":"59","author":"Romero-Ortuno","year":"2011","journal-title":"J Am Geriatr Soc"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/article\/31\/6\/665\/4821720","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article\/31\/6\/665\/4821720","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T17:01:17Z","timestamp":1706029277000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/31\/6\/665\/4821720"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,23]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,1,23]]},"published-print":{"date-parts":[[2018,5,7]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpy010","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,6]]},"published":{"date-parts":[[2018,1,23]]}}}