Orthostatic hypotension is a common, treatable cause of falls, and it is often missed because blood pressure is only measured sitting. A fall of 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing is the usual definition.
Measure after five minutes lying, then at one and three minutes standing, and ask about light-headedness. The commonest causes are drugs, especially antihypertensives, diuretics, alpha-blockers and antipsychotics, along with dehydration and autonomic failure. Reviewing those drugs is often the most effective single step.
- Measure blood pressure lying and at one and three minutes standing in older people who fall.
- Ask about light-headedness on standing, not just blood pressure numbers.
- Review antihypertensives, diuretics, alpha-blockers and antipsychotics when orthostatic hypotension is found.
- Check hydration and consider autonomic causes.
Why it matters
Seated blood pressure misses orthostatic hypotension, one of the most treatable 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