Orthostatic hypotension is a common, treatable cause of falls in older people and is often missed when blood pressure is measured only seated. Antihypertensives, diuretics, alpha-blockers, antidepressants and Parkinson medication are frequent contributors.
Measure blood pressure after five minutes lying, then at one and three minutes after standing. A fall of 20 mmHg systolic or 10 mmHg diastolic, or symptoms on standing, is significant. Review medication first.
- Measure lying and standing blood pressure in every older patient who has fallen.
- Record readings at one and three minutes after standing, and any symptoms.
- Review antihypertensives, diuretics, alpha-blockers and psychotropics when a drop is found.
- Advise slow rising and adequate fluid intake unless contraindicated.
Why it matters
A seated reading misses the commonest reversible cause of falls in older people.
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