No Need to Wait 3 Minutes After Standing to Assess Orthostatic Hypotension

According to a 2011 consensus statement, blood pressure (BP) measurement to assess orthostatic hypotension should be done “within 3 minutes of standing” (Clin Auton Res 2011; 21:69). To determine the value of measuring BP during the first 2 minutes after standing, researchers conducted this prospective cohort study that involved 11,249 middle-aged adults (mean age, 54; many with cardiovascular disease or risk factors, or on medications). Orthostatic hypotension (defined as systolic drop of ≥20 mm Hg or diastolic drop of ≥10 mm Hg) was assessed at baseline, with BP readings taken with an automatic cuff every 25 seconds as many as 5 times after a patient rose from a supine to a standing position.

Presence of orthostatic hypotension at the first measurement (but not at other measurement times) was associated significantly with self-reported history of dizziness on standing. During median follow-up of 23 years, about 12,000 adverse events (i.e., falls, fractures, syncopal episodes, motor vehicle accidents, and death) were recorded. Orthostatic hypotension at measurements 1 and 2 (i.e., within 1 minute) were associated most consistently and strongly with excess risk for all adverse events, except for syncope and death, which were associated significantly with orthostatic hypotension at all five time points.