Orthostatic hypotension is one of the most treatable causes of falls in older adults, and one of the most often missed because blood pressure is only taken sitting. A fall of 20 mm Hg systolic or 10 mm Hg diastolic within three minutes of standing is diagnostic, and symptoms may appear without meeting those numbers. Antihypertensives, alpha-blockers for the prostate, diuretics, antidepressants and levodopa are common culprits.
- Measure blood pressure after five minutes lying and again at one and three minutes standing.
- Record symptoms on standing even if the numbers do not reach the threshold.
- Review antihypertensives, alpha-blockers, diuretics and sedatives in anyone with a postural drop.
- Advise rising slowly, adequate fluid intake and avoiding large carbohydrate meals before standing.
- Repeat the measurement after any medicine change.
Why it matters
A seated blood pressure reading misses one of the most correctable causes of falls.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for geriatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free