Assessment of orthostatic blood pressure: measurement technique and clinical applications

BACKGROUND: Orthostatic hypotension, a decline in erect blood pressure, is the result of an impaired hemodynamic response to an upright posture or a depletion intravascular volume. The measurement of orthostatic blood pressure can be done at the bedside and therefore is easily applied to several clinical disorders. Despite its usefulness, the measurement is often neglected, possibly because of confusion regarding the appropriate measurement technique and suitable application to patient care. METHODS: Pertinent recent medical literature was reviewed. RESULTS: The normal physiologic response to the assumption of an upright posture is a small drop in blood pressure and a slight rise in pulse rate. Orthostatic hypotension is detected by measurement of blood pressure in two or more body positions. An abnormal blood pressure response can be observed with disorders such as syncope, falling, intravascular volume depletion, and autonomic dysfunction; with the treatment of maladies such as hypertension and heart failure; and with the use of several medications. CONCLUSIONS: The measurement of orthostatic blood pressure is an essential clinical tool for the assessment and management of patients affected by common medical disorders.