Criteria Used to Diagnose Orthostatic Hypotension (OH)

To make a diagnosis of Orthostatic Hypotension, a certain set of conditions or criteria need to be met. This set of criteria has been set as guidelines by the physician specialists in cardiology and neurology.

To Diagnose Orthostatic Hypotension (OH)

Criteria for the diagnosis of OH: The basic or classic OH is defined as a decrease in the blood pressure (BP) when the person stands up.¹ The blood pressure (BP) goes down in the first 3 minutes after the person stands up.

To be "classic OH", the systolic blood pressure (top number) has to go down by at least 20 mmHg or the diastolic (bottom number) drops by 10 mmHg or more. If the person gets orthostatic symptoms, like dizziness or lightheaded feeling, vision change, and feeling of weakness, it is considered to be diagnostic ( the diagnosis is made for orthostatic hypotension (OH). If the person does not get these symptoms, there is still a strong likelihood that the person has orthostatic hypotension (OH).

Additional Criteria: In their 2009 Guidelines, the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology, which published the guidelines in collaboration with the Heart Rhythm Society (USA), the American geriatrics Society (AGS) and the American Autonomic Society (AAS) included another potential criteria for the diagnosis: a decrease in systolic (top number)blood pressure (BP) to less than 90 mmHg.⁵

Example:
— The person's BP lying down is 120/80 mmHg. Pulse is 74.
— After standing up for 3 minutes, the blood pressure is 90/64 mm Hg. The pulse is still 74.
— The person feels dizzy, has vision change, & weakness.
— This would be "orthostatic hypotension".

 

Other Names Based on When Symptoms Start

The drop in blood pressure (BP) and symptoms can come at different times.

If the BP drops
   •   Within 15 seconds of standing up - it's called "initial orthostatic hypotension"¹.
   •   In the first 3 minutes after standing up - it's called "classic orthostatic hypotension"¹.
   •   After 3 minutes of standing - it's called "delayed orthostatic hypotension".¹

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To see a comparison of the symptoms , the time symptoms develop the BP and pulse changes, and the diagnosis, go to OI by Time of Symptoms.

 

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Orthostatic Hypotension (OH):
What is OH?
Criteria to diagnose OH
What is NMH?
OH due to low blood volume
OH due to drugs & other causes

Next Topics To Review
Causes of OI
Deconditioning
Getting Medical Care
Taking Care - Everyday Self-Care

 

 

 

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References

1. Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–2817. Abstract. Article PDF.
2. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract
3. Grubb BP, Row P, Calkins H. Postural tachycardia, orthostatic intolerance and the chronic fatigue syndrome. In: Grubb BP, Olshansky B, eds. Syncope: Mechanisms and Management 2nd Ed. Malden, Mass: Blackwell/ Future Press; 2005:225–244.
4. Thieben MJ, Sandroni P, Sletten DM, et al. Postural orthostatic tachycardia syndrome: The Mayo Clinic experience. Mayo Clin Proc. 2007;82:308–313. Abstract. Article PDF.
5. Moya, Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671. Abstract. Article PDF.
6. Low PA, Sandroni P, Joyner and Shen W. Postural Tachycardia Syndrome (POTS). J Cardopvasc Electrophysiology 2009; 20:352-358.  Abstract.  Article PDF
7. Low P, Opfer-Gehrking T, Textor S, Benarroch E, Shen W, Schondorf R, Suarez G,Rummans T. Postural tachycardia syndrome (POTS). Neurology. 1995;45:519–525. Abstract.

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