From the Guidelines
The blood pressure readings of 134/78 sitting and 124/68 standing indicate a normal orthostatic response with no significant orthostatic hypotension, as the decrease from sitting to standing is within the normal physiological range. According to the most recent and highest quality study 1, orthostatic hypotension is typically defined as a drop in systolic blood pressure of at least 20 mmHg or a drop in diastolic blood pressure of at least 10 mmHg within three minutes of standing. In this case, the decrease from sitting to standing (10 mmHg systolic and 10 mmHg diastolic) does not meet the criteria for orthostatic hypotension.
The normal response suggests that the autonomic nervous system is functioning properly to compensate for positional changes by increasing heart rate and peripheral vascular resistance when standing. This is consistent with the findings of the study 1, which highlights the importance of autonomic nervous system function in maintaining blood pressure regulation.
Key points to consider in this scenario include:
- The definition of orthostatic hypotension as a sustained decrease in systolic BP > 20 mmHg, diastolic BP > 10 mmHg, or a sustained decrease in systolic BP to an absolute value < 90 mmHg within 3 min of active standing or head-up tilt of at least 60 degrees 1.
- The importance of monitoring blood pressure in different positions, especially in individuals with symptoms like dizziness upon standing or those taking medications that might affect blood pressure regulation 1.
- The association between classical orthostatic hypotension and increased mortality and cardiovascular disease prevalence, highlighting the need for regular monitoring and management 1.
Overall, no specific intervention is needed for these readings, as they represent normal cardiovascular adaptation to postural change. However, regular monitoring of blood pressure in different positions is still recommended, especially if the person has symptoms like dizziness upon standing or is taking medications that might affect blood pressure regulation.
From the Research
Blood Pressure Readings
- The blood pressure reading of 134/78 mmHg in the sitting position and 124/68 mmHg in the standing position indicates a drop in systolic blood pressure of 10mmHg and a drop in diastolic blood pressure of 10mmHg 2, 3, 4.
- According to the definition of orthostatic hypotension, a drop in systolic blood pressure of at least 20mmHg or a drop in diastolic blood pressure of at least 10mmHg within 3 minutes of standing is considered orthostatic hypotension 2, 3, 4.
- In this case, the drop in systolic blood pressure is less than 20mmHg, but the drop in diastolic blood pressure is 10mmHg, which meets the criteria for orthostatic hypotension 2, 3, 4.
Orthostatic Hypotension
- Orthostatic hypotension is a common disorder, especially in high-risk populations such as elderly subjects and patients with neurological diseases, and is associated with markedly increased morbidity and mortality 2, 4.
- The management of orthostatic hypotension can be challenging, particularly in cases where supine hypertension is associated with severe orthostatic hypotension 2.
- Education of the patient, non-pharmacological measures, and drug adaptation are the cornerstones of treatment for orthostatic hypotension 2, 3, 4.
- Pharmacological treatment, such as fludrocortisone and midodrine, may be necessary in some cases 2, 3, 5, 4, 6.
Treatment and Management
- The goal of therapy for orthostatic hypotension is the relief of symptoms and fall prevention, rather than a predefined blood pressure target 4.
- Treatment always requires education of the patient regarding triggering situations and physiological countermanoeuvers 4.
- Non-pharmacological treatment, such as increasing fluid and salt intake, and pharmacological treatment, such as fludrocortisone and midodrine, can be effective in managing orthostatic hypotension 3, 5, 4, 6.