Orthostatic Hypotension Definition and Diagnosis

Introduction to Orthostatic Hypotension

Orthostatic hypotension is defined as a reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing or during head-up tilt of at least 60 degrees, according to the European Heart Journal 1, 2, 3

Classical OH is characterized by 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, as defined by the European Heart Journal 2, 3
Initial OH is a BP decrease on standing of >40 mmHg for systolic BP and/or >20 mmHg for diastolic BP within 15 seconds of standing, according to the European Heart Journal 2, 3
Delayed OH is defined as OH occurring beyond 3 minutes of head-up tilt or active standing, characterized by a slow progressive decrease in BP, as described by the European Heart Journal 2, 3

Orthostatic hypotension is associated with increased mortality and cardiovascular disease prevalence, according to the European Heart Journal 2, 3
The presence of orthostatic hypotension due to advanced cardiovascular autonomic neuropathy (CAN) is associated with an additional increase in mortality risk, as reported by Diabetes/Metabolism Research and Reviews 4, 5

For diagnosis, blood pressure should be measured after 5 minutes of lying supine, then continued after 1 or 3 minutes of standing, as recommended by the European Heart Journal 6
Orthostatic hypotension should be assessed routinely in diabetic patients even without symptoms, particularly after the age of 50, according to Diabetes/Metabolism Research and Reviews 4, 5, 7