Is checking for orthostatic hypotension less than 1 minute after standing clinically useful?

Not only can it be useful in identifying those with history of dizziness upon standing but it may also predict a higher risk of falls, fracture, syncope and mortality long term. 1

Clinicians (myself included) have often assumed that drops in blood pressure (BP) and brief feeling of light-headedness soon after active standing are too common and “physiologic” to be of clinical utility,1,2 and have often discouraged checking for orthostatic hyotension (OH) sooner than 1 minute.

However, a 2017 report involving over 11,000 middle-aged participants (Atherosclerosis Risk in Communities Study) may make us rethink our position. This prospective study  found a significant association between participant-reported history of dizziness on standing and OH (defined as a drop in BP systolic ≥20 mmHg or diastolic ≥10 mmHg) but only at 1st measurement (mean of 28.0 seconds after standing), not at subsequent ones over a 2 minute period.

The more intriguing finding was the association between OH documented < 1 minute after standing and increased risk of falls, fracture, syncope, and mortality over a median follow-up period of 23 years. Although there were limitations to the study (eg, excluding many patients likely to have more severe OH), it appears that “premature” checking for OH less than a minute after standing  may not be useless!

Most, including the CDC, agree that rechecking the BP at 3 minutes is still indicated to identify those with sustained or delayed OH. 2,3

Also go to a related P4P post: https://pearls4peers.com/2015/12/14/how-can-i-be-sure-that-my-patient-truly-has-orthostatic-hypotension-oh/

References

  1. Juraschek SP, Daya N, Rawlings AM, et al. Comparison of early versus late orthostatic hypotension assessment times in middle-age adults. JAMA Intern Med 2017;1177:1316-1323. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661881/
  2. Singer W, Low PA. Early orthostatic hypotension and orthostatic intolerance-more than an observation or annoyance. JAMA Intern Med 2017;1177:1234-25. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2645144
  3.  CDC. https://www.cdc.gov/steadi/pdf/measuring_orthostatic_blood_pressure-a.pdf. Accessed February 7, 2017.
Is checking for orthostatic hypotension less than 1 minute after standing clinically useful?

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