Is a 61-year-old patient with supine blood pressure of 118/68 mmHg, sitting blood pressure of 108/10 mmHg, and standing blood pressure of 104/68 mmHg at risk for orthostatic hypotension?

Orthostatic Hypotension Assessment

Direct Answer

This patient does NOT meet diagnostic criteria for orthostatic hypotension based on the blood pressure measurements provided. 1, 2

Critical Measurement Issue

The sitting blood pressure reading of 108/10 mmHg appears to be a transcription or measurement error – a diastolic pressure of 10 mmHg is physiologically implausible and incompatible with life. 1, 2 This value should be verified and corrected before any clinical interpretation can be made.

Diagnostic Criteria for Orthostatic Hypotension

Assuming the sitting measurement is erroneous and focusing on the supine-to-standing comparison:

• Supine BP: 118/68 mmHg
• Standing BP: 104/68 mmHg
• Change: 14 mmHg systolic drop, 0 mmHg diastolic change

Orthostatic hypotension requires BOTH of the following criteria within 3 minutes of standing: 3, 1, 2

• Systolic BP drop ≥20 mmHg, OR
• Diastolic BP drop ≥10 mmHg, OR
• Systolic BP falling to absolute value <90 mmHg

This patient's 14 mmHg systolic drop does not meet the ≥20 mmHg threshold required for diagnosis. 1, 4, 5

Proper Measurement Technique

The measurements provided may not have followed standardized protocols: 1, 2

• Blood pressure should be measured after 5 minutes of supine rest (not just "laying")
• Standing measurements should be taken at 1 minute AND 3 minutes after standing
• The arm must be maintained at heart level during all measurements
• If BP continues falling at 3 minutes, measurements should continue until stabilization 1

Clinical Significance of Borderline Findings

While this patient doesn't meet diagnostic criteria, the 14 mmHg systolic drop warrants attention: 3

• In patients over 50 years old, lying and standing BPs should be obtained periodically to monitor for progression 3
• A 14 mmHg drop represents approximately 70% of the diagnostic threshold and may progress over time
• Symptoms are more important than absolute numbers – ask specifically about postural unsteadiness, dizziness, lightheadedness, or fainting upon standing 3, 4

Recommended Next Steps

1. Correct the erroneous sitting BP measurement – repeat with proper technique 1, 2

2. Perform standardized orthostatic vital signs: 1, 2

   • 5 minutes supine rest
   • Measure BP and heart rate supine
   • Measure at 1 minute standing
   • Measure at 3 minutes standing
   • Continue if BP still declining at 3 minutes

3. Assess for symptoms: 3, 4

   • Lightheadedness or dizziness when standing
   • Visual disturbances (blurred vision, dark spots)
   • Weakness, fatigue, or tremulousness
   • Falls or near-falls
   • Coat-hanger pain (neck/shoulder discomfort)

4. Review medications that commonly cause orthostatic hypotension: 3, 2

   • Diuretics
   • Beta-blockers and alpha-blockers
   • Nitrates
   • Antihypertensives

Common Pitfall to Avoid

Do not diagnose orthostatic hypotension based on incomplete or improperly obtained measurements. 1, 2 The sitting BP of 108/10 mmHg is clearly erroneous, and without proper 1-minute and 3-minute standing measurements after adequate supine rest, the diagnosis cannot be reliably established or excluded. Premature diagnosis may lead to unnecessary medication adjustments that could worsen blood pressure control. 3