Physical Exam

Orthostatic Blood Pressure

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Video coming September 2026

How to Perform

Measure blood pressure and heart rate after the patient has rested supine for at least 5 minutes. Then have the patient stand and measure blood pressure again at 1 minute and at 3 minutes of standing. A positive result (orthostatic hypotension) is a sustained fall of at least 20 mmHg in systolic or at least 10 mmHg in diastolic pressure within 3 minutes of standing.

How to Interpret

Autonomic Failure

Failure of compensatory tachycardia

Rule in

Helpful

Rule out

Very helpful

Evidence:Limited

Autonomic Neuropathy

Orthostatic hypotension

Rule in

Very helpful

Rule out

Minimally helpful

Evidence:Limited

Hemorrhage

Severe postural dizziness OR postural pulse increment of at least 30 beats/minute on standing

Rule in

Very helpful

Rule out

Very helpful

Evidence:Limited

Hypovolemia

Severe postural dizziness OR postural pulse increment of at least 30 beats/minute on standing

Rule in

Very helpful

Rule out

—

Evidence:Limited

References

McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999;281(11):1022-1029. doi:10.1001/jama.281.11.1022. PMID: 10086438. Free DARE summary at NCBI Bookshelf NBK67823.
Spallone V, Morganti R, Fedele T, D'Amato C, Maiello MR. Reappraisal of the diagnostic role of orthostatic hypotension in diabetes. Clin Auton Res. 2009;19(1):58-64. PMID: 19199088.
Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology. 1993;43(1):132-137.
Norcliffe-Kaufmann L, Kaufmann H, Palma JA, Shibao CA, Biaggioni I, Peltier AC, Singer W, Low PA, Goldstein DS, Gibbons CH, Freeman R, Robertson D; Autonomic Disorders Consortium. Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies. Ann Neurol. 2018;83(3):522-531. PMID 29405350. Validated by Fanciulli A et al. Ann Neurol. 2020;88(3):643-645. PMID 32596818
Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.