Physical examination maneuver
Orthostatic Blood Pressure
How to Perform
Have the patient lie supine and rest quietly for at least 5 minutes. Bare the upper arm and support it at heart level. Choose an appropriately sized blood-pressure cuff and wrap it around the upper arm with the artery marker centered over the brachial artery. Palpate the brachial or radial pulse while inflating the cuff, and inflate to about 30 mmHg above the point where the pulse disappears. Place the stethoscope over the brachial artery and slowly deflate the cuff at about 2–3 mmHg per second. Record the pressure at which repetitive tapping sounds first become audible as the systolic pressure and the pressure at which the sounds disappear as the diastolic pressure.
Measure the heart rate by palpating the radial pulse with the pads of two fingers and counting the beats for 30 seconds, then doubling the count. If the rhythm is irregular, count for a full 60 seconds. If the peripheral pulse is difficult to assess, auscultate the heart at the apex and count the beats for a full 60 seconds.
Have the patient stand. Keep the cuff on the same arm and support the arm at heart level. Repeat the blood-pressure and heart-rate measurements after about 1 minute of standing and again after about 3 minutes.
Orthostatic hypotension is present when there is a sustained fall in systolic pressure of at least 20 mmHg or in diastolic pressure of at least 10 mmHg within 3 minutes of standing.