Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and ME/CFS, 2022, Vernon et al

[DokaGirl]

A GP more or less said to me about 5 years ago when I commented that it was my diastolic that’s consistently high that they only focus on systolic

I thought that was the case; just systolic was important. That's the impression we may get because that seems to be the focus.

In prep for a surgery I provided systolic BP numbers for a specialist, who told me the diastolic was required too.

It would be helpful if medical messages on basic things like BP were consistent.

 

[Jonathan Edwards]

It would be helpful if medical messages on basic things like BP were consistent.

Indeed. The standard teaching in medicine for the last forty odd years has been that the diastolic is the more important for hypertension. In hypotension the pulse rate is probably more important than either.

 

[Mithriel]

I have the opposite problem. When I have overdone things badly my systolic goes up as my diastolic drops on one occasion it reached 165/52. This has happened a good few times now. I mentioned it to my diabetes nurse but she did not seem interested. Looking at google (I know...) the causes of a wide pulse pressure, like hardening of the arteries are not transient so she did not feel it was important because I have had treated high blood pressure since early 40s (family genetics!) and it is usually about 135/75.

Anyone any idea what it could mean in the context of ME? I feel dizzy and weak when it is happening but it goes away when I have been lying down for a bit.

 

[cassava7]

This study is interesting, as were the previous ones from the Bateman Horne center on orthostatic intolerance in ME.

However, their definition of POTS is incomplete: it is not only a 30BPM increase in heart rate. It must be 1) accompanied by symptoms of orthostatic intolerance; 2) sustained through the remainder of the test once attained; and 3) not accompanied by a drop in blood pressure (a rise in blood pressure is possible in the “hyperadrenergic” POTS subtype).

The initial, momentary drop in blood pressure and subsequent increase in heart rate that happens as a normal response to standing up may explain why 5/26 healthy controls met the 30BPM increase criterion for POTS, but those would be false positives as the increase is not sustained in this case.

Healthy controls were not explicitly asked if they were hypertensive (only if they considered themselves in good general health), so some may have had asymptomatic POT too.

It would help to reanalyze the data in this light to rule out possible false positives for POTS in both healthy controls and patients.

Edit: Dr Lucinda Bateman’s response:

Figure 1 points out that the patients were very symptomatic during the orthostatic testing. Regardless, this isn’t a paper about POTS, and quibbling over which exact terms to use to dx POTS misses the point of the paper.

 

[Hutan]

Has there been any response from the authors to the odd-appearing charts?

 

[LarsSG]

Has there been any response from the authors to the odd-appearing charts?

I emailed Prof. Komaroff, but got an auto-reply that he is on vacation.

 

[Hutan]

Same.

 

[Hutan]

I got a nice reply from Suzanne Vernon; there was a glitch with making the charts for inclusion in the article. She has contacted the journal to replace the incorrect charts with the correct ones.

Edited to add - she appreciated being alerted to the problem.

I did ask if there could be error bars on the points and if it is possible to get access to the data, but she didn't address those queries in her reply.