Orthostatic hypotension is a common, treatable contributor to falls in older people, and it is easily missed by a single sitting reading. Measure blood pressure after the patient has been lying for about five minutes, then at one and three minutes after standing. A fall of 20 mmHg systolic or 10 mmHg diastolic, or symptoms on standing, is significant. A delayed fall may appear only at three minutes, so do not stop at one. If present, review antihypertensives, diuretics, alpha-blockers, nitrates and other contributing drugs before adding anything new.
- Measure lying blood pressure after about five minutes of rest.
- Repeat at one and three minutes after standing.
- Treat a drop of 20 systolic or 10 diastolic, or symptoms, as significant.
- Review blood pressure-lowering and other contributing drugs first.
Why it matters
A five-minute test can uncover a reversible cause of falls that a seated reading hides.
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