From the Guidelines
To test for orthostatic hypotension, have the patient lie down for 5 minutes, then measure their blood pressure and heart rate while supine, and after standing, measure blood pressure at 1 min and/or 3 min, with a threshold for orthostatic hypotension of ≥20/10 mmHg drop, as recommended by the 2024 ESC guidelines 1. The test for orthostatic hypotension is crucial in assessing the body's ability to maintain blood pressure when changing positions, which requires proper autonomic nervous system function and adequate blood volume.
- The patient should be assessed for orthostatic hypotension at the initial visit and if concerning symptoms arise, such as dizziness, lightheadedness, or syncope.
- The measurement of blood pressure after lying may be more sensitive for detecting orthostatic hypotension and may better predict falls, but measurement after sitting may be less feasible in clinical practice 1.
- Factors affecting this response to posture include food ingestion, time of day, medications, ambient temperature, hydration, deconditioning, standing after vigorous exercise, and age, as noted in previous studies 1.
- However, the most recent and highest quality study, the 2024 ESC guidelines, recommends the aforementioned method for testing orthostatic hypotension, prioritizing patient safety and accurate diagnosis 1.
- During the test, it is essential to observe for symptoms and ensure patient safety by having them near a bed or chair and with someone ready to assist if they become unstable.
- The diagnosis of orthostatic hypotension is made when there is a drop in systolic blood pressure of at least 20 mmHg or a drop in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing, as defined by the 2024 ESC guidelines 1.
From the Research
Testing for Orthostatic Hypotension
- Orthostatic hypotension is a common condition associated with adverse cardiovascular and cognitive prognosis 2
- Screening for orthostatic hypotension consists of blood pressure measurements in supine (or sitting) and standing position during clinical consultations 2
- The measurement of blood pressure in standing position during home blood pressure measurements (HBPM) is feasible without altering the quality of the blood pressure readings in seated position 2
- HBPM may improve orthostatic hypotension diagnosis without compromising the quality of the blood pressure readings 2
Methods of Testing
- Blood pressure measurements in supine (or sitting) and standing position during clinical consultations 2
- Home blood pressure measurements (HBPM) with measurements in standing position 2
- Tilt-table test to evaluate the clinical benefit of midodrine hydrochloride in symptomatic orthostatic hypotension 3
Key Considerations
- Orthostatic hypotension is a poorly reproducible clinical condition, and simple measurement carried out during consultations may underestimate the true prevalence of the condition 2
- The success rate of HBPM complying with the ESH criteria is comparable with previously published series of measurements 2
- Nonpharmacologic measures are the key to success in managing orthostatic hypotension 4