Early Assessment in Orthostatic Hypotension More Effective Than Recommendations

Contrary to current guidelines that recommend measuring blood pressure 3 minutes after standing from a supine position to assess orthostatic hypotension (OH), a recent study found that only measurements taken within 60 seconds after standing were significantly associated with long-term outcomes and dizziness.

The prospective cohort study included 11,429 participants between 44 to 66 years of age who were enrolled in the Atherosclerosis Risk Communities Study. Blood pressure from supine to standing position was measured up to 5 times at 25 second intervals. The association between each of the 5 OH measurements was assessed in relation to the participant’s history of dizziness, risk of fall, fracture, syncope, motor vehicle crashes, and all-cause mortality over a median 23 years of follow-up.
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The first measurement taken within 21 to 62 seconds (mean for measurement one: 28 seconds) was the only measurement associated with higher odds of dizziness. In addition, the first measurement was associated with the highest rate of fracture, syncope, and death, while the second measurement, taken within 43 to 93 seconds (mean for measurement two: 53 second) was associated with the highest rate of falls and motor vehicle crashes.

After adjustments, the first measurement was significantly associated with the risk of fall, fracture, syncope, and mortality, and the second measurement was associated with all long-term outcomes, including motor vehicle crashes.

In addition, the researchers found that measurements obtained after 1 minute were not associated with dizziness and were inconsistently associated with individual long-term outcomes.

“In contrast with prevailing recommendations, OH measurements performed within 1 minute of standing were the most strongly related to dizziness and individual adverse outcomes, suggesting that OH be assessed within 1 minute of standing,” the researchers concluded.

—Melissa Weiss

Reference:

Juraschek SP, Daye N, Rawlings AM, et al. Association of history of dizziness and long-term adverse outcomes with early vs later orthostatic hypotension assessment times in middle-aged adults [published online July 24, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.2937.