Orthostatic hypotension - quantification

Q: 72 years old male is transferred from ward/floor to ICU after an episode of hypotension, dizziness, fall, and hip fracture. Patient was admitted two days ago with an exacerbation of his baseline asthma. He was also started on an antihypertensive a day ago by the Hospital Medicine service. The diagnosis of orthostatic hypotension is made. Orthostatic hypotension is defined quantitatively as a drop in systolic blood pressure by? (select one)

A) At least by 10 mmHg fall

B) At least by 20 mmHg fall 

Answer: B

Orthostatic hypotension, also known as postural hypotension is common in patients who are on anti-hypertensive meds, particularly on initiation in older patients. This accounts for a large number of patients with injury risk due to falls. Data shows that antihypertensive treatment in older patients is associated with an increased risk of hip fracture during the first 8 weeks after the start of therapy. Orthostatic hypotension is defined as when, within two minutes of quiet standing, one or more occurs:

• At least a 20 mmHg fall in systolic blood pressure
• At least a 10 mmHg fall in diastolic blood pressure
• Symptoms of cerebral hypoperfusion, such as dizziness

#hemodynamics

#cardiology

References:

1. Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174:588.

2. Butt DA, Mamdani M, Austin PC, et al. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med 2012; 172:1739.