Brief orthostatic test

Before the test the patient should avoid smoking for 4 hours, drinking coffee, tea, cola drinks or other stimulating substances or a heavy meal for 2 hours (but need not be fasting), and alcohol for 1.5 days.

The orthostatic test is performed after 10 minutes of lying supine. Perform the test as follows:

1. Measure blood pressure and heart rate while the patient is supine.
2. The patient stands up quickly and remains standing without support.
3. Measure blood pressure and heart rate immediately and after 2 minutes, and record the patient's symptoms.

NOTE! In patients with atrial fibrillation the blood pressure should be measured with a sphygmomanometer and stethoscope.

Interpretation

The systolic blood pressure usually changes between - 8 and +6 mmHg when standing up. If the systolic blood pressure decreases 20 mmHg or more immediately or at the latest after 2 minutes, the patient has orthostatic hypotension. It can be symptomatic or asymptomatic.

Normally the heart rate increases when standing up (+7 – 22/ min). If the heart rate does not increase, the patient may have dysfunction of the autonomic nervous system (caused e.g. by diabetes, Parkinson's disease, or certain drugs that worsen the symptoms of dysfunction). An even more marked increase in the heart rate may result from dehydration.

Ədəbiyyat

1. Fagard et al. Orthostatic hypotension is a more robust predictor of cardiovascular events than nighttime reverse dipping in elderly. Hypertension 2010;56:56–61
2. Lahrmann et al. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur J Neurol. 2006;13:930–6.
3. Angelousi et al. Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertension 2014;32:1562–71