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Brief Orthostatic Test

Performing the test

  1. Measureblood pressure and heart rate after the patient has been in a supine position for 5 minutes.
  2. The patient stands up quickly.
  3. Measure blood pressure and heart rate 1 and 3 minutes after the patient stood up, and also record the patient's symptoms.

Printable form .

Interpretation

Normally, changing from supine to standing position is followed by a mild decrease (5-10 mmHg) in the systolic blood pressure, a mild elevation (5-10 mmHg) in the diastolic blood pressure and an increase in the heart rate (10-25 beats/min).

In orthostatic hypotension the mechanisms compensating for the blood pressure drop function in an inadequate manner and standing up causes a higher than normal reduction in blood pressure.

  • The systolic blood pressure decreases at least 20 mmHg or the diastolic blood pressure decreases at least 10 mmHg within 3 minutes after standing up, and the patient has clear orthostatic symptoms.
  • Also a decrease of systolic blood pressure to a level below 90 mmHg can be regarded as orthostatic hypotension in a symptomatic patient whose starting blood pressure is low (< 110 mmHg).

Many medications (alpha blocking agents, antidepressants, antipsychotics, diuretics, nitrates, PDE5 inhibitors, antihypertensive drugs, among others) may cause or aggravate orthostatic hypotension.

    References

    • Brignole M, Moya A, de Lange FJ ym. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39(21):1883-1948. [PubMed]
    • Shen WK, Sheldon RS, Benditt DG ym. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017;136(5):e25-e59. [PubMed]
    • Gibbons CH, Schmidt P, Biaggioni I ym. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017;264(8):1567-1582. [PubMed]
    • Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician 2011;84(5):527-36. [PubMed]

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