Utricular dysfunction in patients with orthostatic hypotension

Abstract

Purpose To delineate the association between otolithic dysfunction and orthostatic hypotension (OH).

Methods We retrospectively reviewed the medical records of 382 patients who presented with orthostatic dizziness at a tertiary dizziness center between July 2017 and December 2021. Patients were included for analyses when they had completed ocular (oVEMP) and/or cervical vestibular-evoked myogenic potentials (cVEMP), and head-up tilt table test with a Finometer (n = 155). We compared the results between the patients with OH (n = 38) and those with NOI (normal head-up tilt table test despite orthostatic intolerance, n = 117).

Results Thirty-eight patients with OH were further categorized as either classic (n = 30), delayed (n = 7), or initial (n = 1) types. Multivariable logistic regression showed that OH was associated with high baseline systolic BP (p = 0.046), presence of heart failure (p = 0.016), and unilateral oVEMP abnormalities (p = 0.016). n1 latency of oVEMP were negatively correlated with the maximal changes of systolic blood pressure (BP) in 15 s (ΔSBP15s, p = 0.013), 3 min (ΔSBP3min, p = 0.005) and 10 min (ΔSBP10min, p = 0.002). In contrast, the n1-p1 amplitude was positively correlated with ΔSBP15s (p = 0.029). Meanwhile, p13 latency of cVEMP was negatively correlated with ΔSBP10min (p = 0.018).

Conclusions Our study provides evidence of utricular dysfunction related to OH.