Orthostatic Hypotension - Time / Posture Changes

7/08/02

Question: How much time should elapse between standing and lying when checking for orthostatic hypotension?

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Unique Identifier:11881701

Authors: Lance R. Link ME. Padua M. Clavell LE. Johnson G. Knebel A.

Institution: National Institutes of Health, USA.

Title: Comparison of different methods of obtaining orthostatic vital signs.

Source: Clinical Nursing Research. 9(4):479-91, 2000 Nov.

Abstract: The purpose of this study was to compare two lying and standing procedures for measuring orthostatic vital signs. Thirty-five normotensive participants (mean age 21.6 years)participated in a randomized crossover study. Measures of blood pressure (BP), heart rate, and dizziness were collected at different lying and standing times. AU subjects participated in a standardized walk paced at 4 miles per hour prior to lying. Using analysis of variance (ANOVA) with post hoc contrasts, the mean systolic BP differed between 5 and 10 minutes of lying (F = 21.33, p < .001) and the mean diastolic BP tended to differ between those time points (F = 5.23, p < .03). The mean standing systolic BP and dizziness rating were different between 0- and 2-minute intervals (F = 8.36, p < .01 and F = 7.15, p < .10). In normotensive participants following standardized exercise, orthostatic vital signs stabilized after lying 10 minutes.

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Unique Identifier:9587084

Authors: Robertson D. DesJardin JA. Lichtenstein MJ. Robertson D. Investigator: Robertson D.

Institution: Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee 37232-2195, USA. david.robertson@mcmail.vanderbilt.edu Investigator Affiliation: Vanderbilt U, Nashville TN

Title: Distribution and observed associations of orthostatic blood pressure changes in elderly general medicine outpatients.

Source: American Journal of the Medical Sciences. 315(5):287-95, 1998 May.

Abstract: Factors associated with orthostatic blood pressure change in elderly outpatients were determined by surveying 398 medical clinical outpatients aged 65 years and older. Blood pressure was measured with random-zero sphygmomanometers after patients were 5 minutes in a supine and 5 minutes in a standing position. Orthostatic blood pressure changes were at normally distributed levels with systolic and diastolic pressures dropping an average of 4 mm Hg (standard deviation [SD]=15 mm Hg) and 2 mm Hg (SD=11 mm Hg), respectively. Orthostatic blood pressure changes were unassociated with age, race, sex, body mass, time since eating, symptoms, or other factors. According to multiple linear regression analysis, supine systolic pressure, chronic obstructive pulmonary disease (COPD), and diabetes mellitus were associated with a decrease in systolic pressure on standing. Hypertension, antiarthritic drugs, and abnormal heartbeat were associated with an increase in systolic pressure on standing. For orthostatic diastolic pressure changes, supine diastolic pressure and COPD were associated with a decrease in diastolic pressure on standing. Congestive heart failure was associated with an increase in standing diastolic pressure. Using logistic regression analysis, only supine systolic pressure was associated with a greater than 20-mm Hg drop in systolic pressure (n=53, prevalence=13%). Supine diastolic pressure and COPD were the only variables associated with a greater than 20-mm Hg drop in diastolic pressure (n=16, prevalence=4%). These factors may help physicians in identifying older persons at risk for having orthostatic hypotension.

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Unique Identifier:2312932

Authors: Wandel JC.

Institution: Beth Israel Hospital, Boston, MA 02215.

Title: The use of postural vital signs in the assessment of fluid volume status.

Source: Journal of Professional Nursing. 6(1):46-54, 1990 Jan-Feb.

Abstract: Postural or orthostatic vital signs, although frequently used in many clinical settings to aid in the diagnosis of fluid volume disturbance, can be a source of confusion. Practitioners often have questions about how to perform the test and may be uncertain about what results mean in various clinical situations. Some of this confusion is reflected in the literature, where studies on normal orthostatic responses seem to contradict clinically used parameters of "normal," and where very few studies appear on evaluating unusual responses as indicators of patients' fluid volume status. A review of existing literature is presented, in which relevant data are reviewed in terms of their impact on the use of this clinical sign. Recommendations regarding the use of the orthostatic test are given.

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