Orthostatic Hypotension Assessment and Management

Definition and Diagnostic Criteria

Classical orthostatic hypotension is defined as a sustained decrease in systolic BP ≥20 mmHg, diastolic BP ≥10 mmHg, or a sustained decrease in systolic BP to an absolute value <90 mmHg within 3 minutes of active standing or head-up tilt of at least 60 degrees, as recommended by the European Society of Cardiology 1, 2
In cases of supine hypertension, a systolic BP drop ≥30 mmHg should be considered, according to the European Society of Cardiology 1, 2

Classical OH occurs within 3 minutes of standing with BP decrease meeting the above criteria, as defined by the European Society of Cardiology 1, 2
Initial OH is characterized by BP decrease of >40 mmHg systolic or >20 mmHg diastolic within 15 seconds of standing, with spontaneous recovery within 40 seconds, as described by the European Society of Cardiology 1, 2
Delayed OH is defined as OH occurring beyond 3 minutes of standing, characterized by a slow progressive decrease in BP, according to the European Society of Cardiology 1, 2

OH is associated with increased mortality and cardiovascular disease prevalence, as reported by the European Society of Cardiology 1, 2
Symptoms depend more on the absolute BP level than the magnitude of the fall and may include dizziness, light-headedness, fatigue, weakness, and visual disturbances, as noted by the European Society of Cardiology 1, 2

BP should be measured in both arms at the first visit, as a between-arm systolic BP difference of >10 mmHg is associated with increased cardiovascular risk, as recommended by the European Society of Cardiology 3, 4
Assessment for orthostatic hypotension should be performed at initial diagnosis of elevated BP or hypertension and thereafter if suggestive symptoms arise, according to the European Society of Cardiology 4
The assessment should be performed after the patient has been lying or sitting for 5 minutes, as recommended by the European Society of Cardiology 4
For accurate diagnosis, use validated and calibrated devices with correct measurement technique, as suggested by the European Society of Cardiology 3, 4