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Diagnostic criteria for initial orthostatic hypotension: a narrative review

Clinical Autonomic Research volume 31, pages 685–698 (2021)Cite this article

Abstract

Abnormalities in orthostatic blood pressure changes upon active standing are associated with morbidity, mortality, and reduced quality of life. However, over the last decade, several population-based cohort studies have reported a remarkably high prevalence (between 25 and 70%) of initial orthostatic hypotension (IOH) among elderly individuals. This has raised the question as to whether the orthostatic blood pressure patterns in these community-dwelling elderly should truly be considered as pathological. If not, redefining of the systolic cutoff values for IOH (i.e., a value ≥ 40 mmHg in systolic blood pressure in the first 15 s after standing up) might be necessary to differ between normal aging and true pathology. Therefore, in this narrative review, we provide a critical analysis of the current reference values for the changes in systolic BP in the first 60 s after standing up and discuss how these values should be applied to large population studies. We will address factors that influence the magnitude of the systolic blood pressure changes following active standing and the importance of standardization of the stand-up test, which is a prerequisite for quantitative, between-subject comparisons of the postural hemodynamic response.

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Authors and Affiliations

  1. Department of Internal Medicine, Zuyderland Medical Centre, PO-box 5500, 6130 MB, Sittard, The Netherlands

    Daan J. L. van Twist

  2. Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Mark P. M. Harms & Veera K. van Wijnen

  3. Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada

    Victoria E. Claydon

  4. Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Roy Freeman

  5. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

    William P. Cheshire

  6. Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Wouter Wieling

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  1. Daan J. L. van Twist
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van Twist, D.J.L., Harms, M.P.M., van Wijnen, V.K. et al. Diagnostic criteria for initial orthostatic hypotension: a narrative review. Clin Auton Res 31, 685–698 (2021). https://doi.org/10.1007/s10286-021-00833-2

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Keywords

  • Orthostatic hypotension
  • Initial orthostatic hypotension
  • Postural blood pressure changes