Potential relationship between chronic venous insufficiency and orthostatic hypotension

Abstract

Background

Symptoms of Orthostatic Hypotension have been well-documented for decades, but identifying the cause is often elusive. While many cases are attributed to autonomic dysfunction, drug side effects, and systemic diseases, there remain a significant number of cases where a clear etiology is not found.

Methods

Medical records of 646 patients at our vein clinics with venous insufficiency were retrospectively reviewed from 2013 to 2019. Orthostatic vitals were measures at initial visit and post venous ablations. We measured the degree of decrease in systolic BP, diastolic BP, and increase in heart rate associated with change of position from sit to stand. Positive orthostatic was assigned for systolic drop of 20 mmHg or diastolic drop of 10 mmHg or heart rate increase of 10 bpm. Patients had their initial and final vital sign fluctuations analyzed with statistical regression.

Results

Of the 178 positive patients out of 646 total), 59 showed a Systolic drop of 20 mmHg or greater, 24 showed a Diastolic drop of 10 mmHg or greater, and 123 showed a rise in HR by 10 bpm or greater. Data regression showed that after ablative vein treatments, the magnitude of drop in BP (systolic or diastolic), or increase in HR, were significantly reduced (systolic pressure (p ≤ 0.001), diastolic pressure (p ≤ 0.001), and heart rate spike (p ≤ 0.001).

Conclusion

Our data suggests that venous ablative leg vein treatments might play a significant role in improving orthostatic vital signs. Venous assessment and treatment may offer a potential therapeutic avenue for patients with resistant orthostatic intolerance. However, venous insufficiency needs more investigation in patients with OH to further understand the underlying physiological mechanism.