Do blood pressure readings of 150/80 mmHg (millimeters of mercury) when lying down and 160/90 mmHg when standing up indicate orthostatic hypotension?

Blood Pressure Readings of 150/80 Lying Down and 160/90 Standing Up Do Not Indicate Orthostatic Hypotension

The blood pressure readings of 150/80 mmHg when lying down and 160/90 mmHg when standing up do not indicate orthostatic hypotension, but rather show a normal physiologic response to positional change. 1, 2

Definition of Orthostatic Hypotension

• Orthostatic hypotension is defined as a reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing or during head-up tilt of at least 60 degrees 2
• For a diagnosis of orthostatic hypotension, there must be a decrease in blood pressure upon standing, not an increase 1, 3
• The proper assessment requires measuring blood pressure after 5 minutes of rest in the supine position, followed by measurements at 1 minute and 3 minutes after standing 3

Analysis of the Provided Blood Pressure Readings

• The readings show an increase in blood pressure from 150/80 mmHg (lying down) to 160/90 mmHg (standing up), representing a rise of 10 mmHg systolic and 10 mmHg diastolic 1, 2
• This pattern is the opposite of what defines orthostatic hypotension, which requires a drop in blood pressure upon standing 2, 4
• A slight increase in blood pressure upon standing can be a normal physiologic response in some individuals 3

Types of Orthostatic Blood Pressure Changes

• Classical orthostatic hypotension: sustained decrease in systolic BP ≥20 mmHg, diastolic BP ≥10 mmHg, or a sustained decrease in systolic BP to <90 mmHg within 3 minutes of standing 2, 3
• Initial orthostatic hypotension: BP decrease >40 mmHg systolic and/or >20 mmHg diastolic within 15 seconds of standing, with spontaneous recovery within 40 seconds 3
• Delayed orthostatic hypotension: BP decrease occurring beyond 3 minutes of standing 3

Clinical Considerations

• The European Society of Cardiology recommends assessing for orthostatic hypotension (≥20 systolic BP and/or ≥10 diastolic BP mmHg drop) at the initial diagnosis of elevated BP or hypertension and thereafter if suggestive symptoms arise 1
• Both blood pressure readings (150/80 and 160/90 mmHg) indicate elevated blood pressure/hypertension that requires evaluation and management 1
• The rise in blood pressure upon standing may be related to sympathetic activation, which is a normal compensatory mechanism 3

Potential Concerns with the Blood Pressure Readings

• Both readings indicate elevated blood pressure that requires medical attention 1
• The proper technique for measuring orthostatic changes includes resting supine for 5 minutes before the first measurement and then standing for 1-3 minutes before the second measurement 1, 2
• Multiple measurements may be needed to confirm the diagnosis of hypertension 1
• Special consideration should be given to proper measurement technique, including using a validated and calibrated device 1

Common Pitfalls in Orthostatic Hypotension Assessment

• Failure to allow adequate rest time (5 minutes) before the baseline supine measurement 2, 3
• Not maintaining the arm at heart level during all measurements 3
• Misinterpreting a rise in blood pressure upon standing as orthostatic hypotension 2, 4
• Not considering that some automated oscillometric BP monitors may not be accurate in certain conditions like atrial fibrillation 1