How is orthostatic hypotension assessed?

• A. Measure blood pressure and heart rate in supine, seated, and standing positions to detect a drop in BP ≥20 mmHg systolic or ≥10 mmHg diastolic
• B. Measure blood pressure after meals
• C. Measure blood pressure in standing position only
• D. Measure blood pressure while lying prone

Answer: (A)

Orthostatic hypotension is diagnosed by watching how blood pressure and heart rate change as a person moves from lying down to standing. The key is to compare measurements in different positions, not just one posture.

Start with the person resting supine for several minutes and record blood pressure and heart rate. Then have the person stand and measure again within about 3 minutes. If standing isn’t possible, measuring in a seated position helps document the change. The important part is looking for a drop in blood pressure when moving upright: a decrease of 20 mmHg or more in systolic pressure, or 10 mmHg or more in diastolic pressure. Heart rate is also recorded because an appropriate increase in heart rate can accompany the BP drop; if the heart rate doesn’t rise as expected, it can indicate autonomic dysfunction contributing to the problem.

This approach directly demonstrates the positional BP change that defines orthostatic hypotension, whereas measuring only in one position or using a different scenario (like after meals or lying prone) does not reliably identify it.