In Assessing Patients for Orthostatic Hypotension, Start with Supine Blood Pressure Measurements

When you assess patients for orthostatic hypotension (OH), do you have them go from supine to standing, or from seated to standing? Researchers compared the two methods, using data collected in a previously published trial of vitamin D and falls in older adults (age, ≥70) who were at above-average risk for falls (NEJM JW Gen Med Feb 1 2021 and Ann Intern Med 2021; 174:145). For 534 participants, both supine-to-standing and seated-to-standing orthostatic blood pressure measurements were obtained as many as 4 times during the 2-year study. For both protocols, measurements were done several times during the 3 minutes after standing. Two thirds of patients had hypertension, managed with one or more antihypertensive drugs.

OH (systolic drop of ≥2…