Orthostatic Blood Pressure Measurement Protocol for Dizziness

Measurement Technique

The European Society of Cardiology recommends measuring orthostatic blood pressures twice: once at 1 minute and once at 3 minutes after standing, following 5 minutes of rest in the sitting or lying position 1, 2
The patient should rest for 5 minutes in either the sitting or lying position before beginning measurements, as recommended by the European Society of Cardiology 1, 2
Blood pressure should be measured at baseline while the patient is still seated or lying, according to the European Society of Cardiology guidelines 1, 2
Blood pressure should be measured at 1 minute after standing to capture early orthostatic changes, as suggested by the European Society of Cardiology 1, 2
Blood pressure should be measured at 3 minutes after standing to detect delayed orthostatic hypotension, as recommended by the European Society of Cardiology 1, 2

Orthostatic hypotension is defined as a drop of ≥20 mmHg systolic or ≥10 mmHg diastolic blood pressure at either the 1-minute or 3-minute measurement, according to the European Society of Cardiology 1, 2

The European Society of Cardiology recommends assessing for orthostatic hypotension at the initial visit and thereafter whenever concerning symptoms arise 1, 2
In patients with established hypertension, orthostatic measurements should be performed at the first visit and subsequently if symptoms develop, as suggested by the European Society of Cardiology 4

The 1-minute measurement detects initial orthostatic hypotension and classical orthostatic hypotension, as described by the European Heart Journal 3
The 3-minute measurement identifies delayed orthostatic hypotension, which develops after 3 minutes of standing and may be followed by reflex syncope, according to the European Heart Journal 3