IN-CLINIC ORTHOSTATIC MEASUREMENTS MAY HELP IDENTIFY nOH

Orthostatic measurements taken after a patient is supine for 5 minutes (sitting is an acceptable alternative) and after standing for 1 minute and 3 minutes may help identify neurogenic orthostatic hypotension (nOH).1-3 It is important to note that not all patients experience nOH symptoms immediately following a postural change. Patients may need assistance while orthostatic measurements are being taken, as a symptomatic episode may occur immediately or a few minutes after standing, and may increase the risk of falling.1,3-5 

Recommendations from the Centers for Disease Control and Prevention include the following2:

The four steps of in-clinic orthostatic measurement
in-clinic-steps-step-1
in-clinic-steps_step-2
in-clinic-steps-step-3
in-clinic-steps_step-4
  • Healthy, normally volume-replete individuals will typically experience a systolic blood pressure drop of <10 mm Hg, an approximate increase of 2.5 mm Hg in diastolic blood pressure, and a 10–20 bpm increase in heart rate5,6 -These postural adjustments to blood pressure are initiated by adequate release of norepinephrine7
  • Any heart rate changes greater than 15 bpm within 3 minutes of standing suggest non-neurogenic orthostatic hypotension5,8
  • If a symptomatic patient’s heart rate changes less than 15 bpm within 3 minutes of standing, he or she may have nOH5,8
REFERENCES
  1. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324.
  2. Centers for Disease Control and Prevention. Measuring orthostatic blood pressure. https://www.cdc.gov/steadi/pdf/STEADI-Assessment-MeasuringBP-508.pdf. Accessed January 25, 2019.
  3. Low PA, Opfer-Gehrking TL, McPhee BR, et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995;70(7):617-622.
  4. Rascol O, Perez-Lloret S, Damier P, et al. Falls in ambulatory non-demented patients with Parkinson's disease. J Neural Transm. 2015;122:1447-1455.
  5. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567-1582.
  6. Naschitz JE, Slobodin G, Elias N, Rosner I. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J. 2006;82:246-253.
  7. Kuritzky L, Espay A, Gelblum J, Payne R, Dietrich E. Diagnosing and treating neurogenic orthostatic hypotension in primary care. Postgrad Med. 2015;127(7):702-715.
  8. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.