From the Guidelines
To complete orthostatic vitals, patients should be assessed after 5 minutes of rest in the sitting or lying position, with blood pressure measured at 1 minute and/or 3 minutes after standing, using a threshold of ≥20/10 mmHg drop in systolic and diastolic blood pressure to define orthostatic hypotension. This approach is based on the most recent guidelines for the management of elevated blood pressure and hypertension, as outlined in the 2024 European Society of Cardiology guidelines 1.
Key Steps for Orthostatic Vitals
- Have the patient rest in a sitting or lying position for 5 minutes.
- Measure blood pressure after the rest period.
- Then, have the patient stand up and measure blood pressure at 1 minute and/or 3 minutes after standing.
- Compare the blood pressure readings to determine if there is a significant drop, defined as ≥20/10 mmHg.
Importance of Orthostatic Vitals
Orthostatic hypotension can result from various conditions, including dehydration, medication effects, autonomic dysfunction, or blood loss, making the assessment of orthostatic vitals valuable for patients with symptoms like dizziness, syncope, or suspected volume depletion. The 2018 ESC guidelines for the diagnosis and management of syncope also discuss the importance of identifying orthostatic hypotension, highlighting its association with increased mortality and cardiovascular disease prevalence 1.
Patient Safety and Documentation
Ensure patient safety throughout the process, especially when standing, as significant orthostatic changes may cause dizziness or fainting. Document all measurements, time intervals between position changes, and any symptoms the patient experiences. This thorough documentation is crucial for accurate diagnosis and appropriate management of orthostatic hypotension.
From the Research
Orthostatic Vitals Procedure
To complete orthostatic vitals, the following steps can be taken:
- Take the patient's blood pressure while they are in a supine position 2
- Have the patient stand up and take their blood pressure again within 3 minutes of standing 2
- Compare the two blood pressure readings to determine if there is a significant drop in blood pressure, which is defined as a drop of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure 2
Factors to Consider
When completing orthostatic vitals, consider the following factors:
- Medications that may be contributing to orthostatic hypotension, such as diuretics, vasodilators, and psychoactive drugs 3
- Underlying medical conditions, such as neurogenic or non-neurogenic orthostatic hypotension 4
- The patient's age and mobility, as orthostatic hypotension is more common in older adults 5, 2
Management and Treatment
If orthostatic hypotension is diagnosed, management and treatment may include:
- Non-pharmacological approaches, such as lifestyle modifications and counterpressure maneuvers 4
- Pharmacological agents, such as fludrocortisone and midodrine, to help improve standing blood pressure 5, 6, 2
- Education and patient-oriented approaches to help manage orthostatic hypotension and prevent complications 5, 4