Postural Hypotension (PH)

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How do Patients Present?


Postural Hypotension (PH)




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Postural Hypotension (PH)

“I cannot let my blood pressure rise because someone wishes to spread his or her bad day around as if to dilute instead of multiply it,” is a quote by Thomm Quackenbush. According to Gilani et al. (2021), “Postural hypotension, also called orthostatic hypotension, is an abnormal drop in blood pressure on standing, and it impairs quality of life and increases risk of falls, cardiovascular disease, depression, dementia and death” (p.2). According to McDonagh et al. (2021), “Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care” (p.1). “PH prevalence varies according to definition, population, care setting and measurement method” (McDonagh et al., 2021, p.1). “Current National Institute for Health and Care Excellence (NICE) hypertension guidelines advise testing for PH in the presence of type 2 diabetes, postural symptoms or aged 80 or over; European guidelines also suggest checking in older people and those with diabetes” (McDonagh et al., 2021, p.1). “Whilst PH is routinely tested for in primary care when symptoms are reported, we have found that it is only considered one-third of the time for older people and rarely with diabetes, in the absence of symptoms” (McDonagh et al., 2021, p.1). “Since the majority of people with PH are asymptomatic, they are likely to go undetected under current practices, placing them at avoidable risk of sequelae’ (McDonagh et al., 2021, p.1). “In 2011, a consensus definition for PH: a sustained reduction in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 min of rising to a standing position, was proposed” (McDonagh et al., 2021, p.1). “However, many other definitions of PH exist; reported prevalence estimates are likely dependent on the definition used, making this a source of variance and uncertainty around diagnosis of PH” (McDonagh et al., 2021, p.1). “Prevalence may also vary depending on the method of BP measurement, population and care setting under investigation and the prevalence of PH has been reported as ranging from 2 to 57% in community settings, primary care and institutional care cohorts; increasing prevalence have been associated with older age, diabetes and hypertension” (McDonagh et al., 2021, p.1). “The large variation of reported prevalences may create uncertainty for clinicians as to who should be assessed for PH” (McDonagh et al., 2021, p.1). “By describing the prevalences of PH in settings and conditions relevant to primary care and identifying factors associated with greater prevalence, we aim to raise awareness of those patients most likely to have asymptomatic PH” (McDonagh et al., 2021, p.1). “Such evidence could counteract clinical inertia and facilitate rational choices, in the face of rising workload, as to when to invest time in testing for PH, and increased recognition of PH would permit appropriate interventions, such as review of medications, to reduce risks of falls and other sequelae” (McDonagh et al., 2021, p.1). The group[p] more prone to postural hypertension is the elderly.

Postural Hypotension in the Elderly

The elderly are the group that is more prone to postural hypertension. According to Papismadov et al. (2019), “Postural hypotension (PH) is a very common and often symptomatic disorder among elderly patients’ (p.1). “In this population, the prevalence of PH can be as high as 65−75%” (Papismadov et al., 2019, p.3). “Among acutely ill elderly inpatients, the prevalence of PH is particularly high due to an additive effect of multiple predisposing factors for non-neurogenic PH, and such patients are often weak, connected to medical devices, and at a high risk for symptomatic standing PH during their ambulation following bed rest” (Papismadov et al., 2019, p.3). According to Logan et al. (2017), “Orthostatic hypotension in the elderly can cause a variety of symptoms and is a frequent cause of syncope (transient loss of consciousness, rapid onset and short duration) that may contribute to morbidity, disability and even death, because of the potential risk of substantial injury” (p.3). According to McLeod et al. (2017), “The strong dependence of cognitive performance on BP is a particular concern in older adults for several reasons” (p.2). “First, BP, in particular diastolic blood pressure (DBP), commonly falls in individuals above the age of 60” (McLeod et al. (2017, p.2). “In addition, age-related drops in BP can be significantly exacerbated by orthostatic influences, and upon taking an upright posture such as quiet sitting, gravitational forces acting on the blood supply produce a rapid translocation of 300 to 800 ml of blood into the legs, and continued upright posture leads to extensive fluid extravasation into the lower limb tissues” (McLeod et al. (2017, p.2). “Therefore, evaluating standing PH in older patients may be difficult and potentially dangerous, and sitting before standing is recommended and in this patient population, rates of seated PH (16−56%) are generally lower than those of standing PH (22−75%)” (Papismadov et al., 2019, p.3). Thus, the elderly are the group that is more prone to postural hypertension due to an additive effect of multiple predisposing factors for non-neurogenic PH, and such patients are often weak.

How do Patients Present?

There are many symptoms of postural hypertension. According to Gilani et al. (2021), “Patients may present with light-headedness (feeling faint or woozy), or dizziness (spinning symptoms or feeling off balance) triggered by changes in posture” (p.1). “These symptoms usually resolve with lying down or sitting, and the symptoms may occur first thing in the morning, as the patient gets up from bed, or throughout the day, as they change position from lying to standing, sitting to standing, or even lying to sitting” (Gilani et al., 2021, p.1). “Less well-recognized symptoms of postural hypotension, which are also transient and resolve with lying or sitting down, are shown, and it is not known how diagnostic or common these symptoms are, but if they occur in relation to changes in posture, they should prompt clinicians to check for postural hypotension” (Gilani et al., 2021, p.1). “Some patients have no symptoms: in a small observational study, about a third had postural hypotension but were asymptomatic with it, while other patients may present with transient loss of consciousness or falls” (Gilani et al., 2021, p.1). “PH assessment in patients includes measurement of BP and heart rate after lying supine for five minutes and after standing upright for one to three minutes” (Ali et al., 2020, p.1). “Positive head-up tilt-table results demonstrate the above-described changes if the head-up tilt position is kept for three minutes, at an angle of a minimum of 60 degrees and establishing the diagnosis of PH may require monitoring BP for several days” (Ali et al., 2020, p.1). “For this purpose, it is necessary to record these patients’ vital signs at different times of the day and after certain possible triggers such as meals, medications, and exercise” (Ali et al., 2020, p.1). “Due to nocturnal natriuresis, the symptoms of hypotension tend to be more frequent in the early hours of the morning and it is recommended to measure BP at this time to obtain a more sensitive measure for diagnosis” (Ali et al., 2020, p.1). “The correct diagnosis of PH also requires a medical practitioner to take an exhaustive clinical history that includes comorbidities, medication compliance, current symptoms, detailed physical examination with BP measurements, electrocardiogram, general laboratory tests (complete hematology and glycemic and metabolic profiles with the objective to rule out metabolic, renal, or hematologic causes)” (Ali et al., 2020, p.1). Thus, there are many symptoms of postural hypertension and these symptoms usually resolve with lying down or sitting and the symptoms may occur first thing in the morning.


In conclusion, postural hypertension is a deadly disease caused by a sudden drop in an individual’s blood pressure when they stand. Its main symptoms include, the patients feeling lightheaded and also dizzy. The elderly are the group that is more prone to postural hypertension due to an additive effect of multiple predisposing factors for non-neurogenic PH and such patients are often weak. There are many symptoms of postural hypertension and these symptoms usually resolve with lying down or sitting and the symptoms may occur first thing in the morning. By understanding the signs and also the main causes of postural hypertension, we can be able to effectively manage it so as to control it and lead quality lives.




Ali, A., Ali, N. S., Waqas, N., Bhan, C., Iftikhar, W., Sapna, F. N. U., … & Ahmed, A. (2018). Management of orthostatic hypotension: a literature review. Cureus, 10(8).

Gilani, A., Juraschek, S. P., Belanger, M. J., Vowles, J. E., & Wannamethee, S. G. (2021). Postural hypotension. bmj, 373.

Logan, A., Marsden, J., Freeman, J., & Kent, B. (2017). Effectiveness of non-pharmacological interventions in treating orthostatic hypotension in the elderly and people with a neurological condition: a systematic review protocol. JBI Evidence Synthesis, 15(4), 948-960.

McDonagh, S. T., Mejzner, N., & Clark, C. E. (2021). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC Family Practice, 22, 1-23.

McLeod, K. J., & Jain, T. (2017). Postural hypotension and cognitive function in older adults. Gerontology and Geriatric Medicine, 3, 2333721417733216.

Papismadov, B., Tzur, I., Izhakian, S., Barchel, D., Swarka, M., Phatel, H., … & Gorelik, O. (2019). High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients. Geriatric Nursing, 40(6), 558-564.




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