Incidence and outcome of orthostatic hypotension in stroke patients undergoing rehabilitation

Objectives: To document the incidence and outcome of orthostatic hypotension in stroke patients undergoing rehabilitation and to determine clinical variables associated with it. Design: Cohort study. Setting: Inpatient setting of a tertiary rehabilitation center. Participants: Seventy-one stroke patients (41 men, 30 women; mean age, 58.4+/-10.7 y) with a first clinical stroke, admitted for rehabilitation within 4 weeks of the stroke. Interventions: Not applicable. Main Outcome Measures: Patients' blood pressure was measured in supine position and on tilting at 90degrees within 3 days of admission. Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) of 20mmHg or more. Results: Orthostatic hypotension was present in 37 (52.1%) patients, of whom 13 had severe hypotension (standing SBP, less than or equal to 100mmHg). Twelve (32.4%) patients with orthostatic hypotension were positive for hypotensive symptoms and signs, with 2 patients experiencing near syncope. Orthostatic hypotension was significantly associated with older patients, a lower admission functional status (as measured on the Modified Barthel Index), and more severe hemiparesis. It was, however, not related with the site of stroke or the use of antihypertensives. On discharge, orthostatic hypotension had resolved in 23 patients. The presence of orthostatic hypotension did not influence functional outcome or the length of stay in rehabilitation. Conclusion: Orthostatic hypotension was common in stroke patients undergoing inpatient rehabilitation. It should be suspected in older patients who have more severe hemiparesis and a lower functional status.