Clinical Autonomic Research

, Volume 27, Issue 1, pp 31–39 | Cite as

Reliability of orthostatic beat-to-beat blood pressure tests: implications for population and clinical studies

  • C. Finucane
  • G. M. Savva
  • R. A. Kenny
Research Article



To assess the test–retest reliability of orthostatic beat-to-beat blood pressure responses to active standing and related clinical definitions of orthostatic hypotension.


A random sample of community-dwelling older adults from the pan-European Survey of Health, Ageing and Retirement in Europe, Ireland underwent a health assessment that mimicked that of the Irish Longitudinal Study on Ageing. An active stand test was performed using continuous blood pressure measurements. Participants attended a repeat assessment 4–12 weeks after the initial measurement. A mixed-effects regression model estimated the reliability and minimum detectable change while controlling for fixed observer and time of day effects.


A total of 125 individuals underwent repeat assessment (mean age 66.2 ± 7.5 years; 55.6% female). Mean time between visits was 84.3 ± 23.3 days. There was no significant mean difference in heart rate or blood pressure recovery variables between the first and repeat assessments. Minimum detectable change was noted for changes from resting values in systolic blood pressure (26.4 mmHg) and diastolic blood pressure (13.7 mmHg) at 110 s and for changes in heart rate (10.9 bpm) from resting values at 30 s after standing. Intra-class correlation values ranged from 0.47 for nadir values to 0.80 for heart rate and systolic blood pressure values measured 110 s after standing.


Continuous orthostatic beat-to-beat blood pressure and related clinical definitions show low to moderate reliability and substantial natural variation over a 4–12-week period. Understanding variation in measures is essential for study design or estimating the effects of orthostatic hypotension, while clinically it can be used when evaluating longer term treatment effects.


Reliability Orthostatic blood pressure Impaired blood pressure stabilisation Orthostatic hypotension Syncope 



The authors would like to acknowledge the contribution of the participants and members of the TILDA and SHARE teams. Funding for TILDA was received from the Atlantic Philanthropies, the Irish Government and Irish Life plc. The TILDA-SHARE collaboration was funded by National Institute for Ageing Grant No. R21 AG040387.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

10286_2016_393_MOESM1_ESM.docx (485 kb)
Supplementary material 1 (DOCX 484 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Medical Physics and BioengineeringMercer’s Institute for Successful Ageing, St. James’s HospitalDublinIreland
  2. 2.The Irish Longitudinal Study on Ageing (TILDA), Department of Medical GerontologyTrinity CollegeDublinIreland
  3. 3.School of Health Sciences, Norwich Research ParkUniversity of East AngliaNorwichUK

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