MedicalResearch.com Interview with:
Stephen P. Juraschek, MD, PhD
Instructor of Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Many adults experience dizziness and light-headedness when they stand up. This is more common in older adults and is related to risk of falling, fractures, fainting, car crashes, and early death. These symptoms are thought to be caused by a drop in blood pressure after standing also called orthostatic hypotension. However, if measured at the wrong time it is possible to miss this important clinical sign.
For over 2 decades (since 1996), it has been recommended that orthostatic hypotension be identified by measuring blood pressure within 3 minutes of standing. Furthermore, it was also thought that measurements immediately after standing be avoided because they might be inaccurate (based on fluctuation in blood pressure immediately after standing). As a result, a lot of clinical protocols instructing healthcare staff on measuring orthostatic blood pressure encourage measurement at 3 minutes, but this has not been scientifically evaluated.
MedicalResearch.com: What are the main findings?
Response: In a large observational study, we compared repeat blood pressure measurements in middle-aged adults that were performed at about 25sec, 50sec, 75sec, 100sec, and 115sec after standing to see which was the most informative for dizziness with standing and risk for future falls, fractures, fainting spells, car crashes, and death.
We found that earlier measurements within 1 minute of standing were the most informative for symptoms and long-term outcomes. This has important ramifications for how this measurement is assessed in clinical practice.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Orthostatic hypotension is an important clinical sign. Assessments of orthostatic hypotension performed within 1 minute of standing were the most strongly related to dizziness and individual adverse outcomes. This suggests that orthostatic hypotension be assessed within 1 minute of standing.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Other aspects of orthostatic hypotension should also be evaluated including the threshold used for defining orthostatic hypotension (a drop of 20 mm Hg for systolic blood pressure or 10 mm Hg for diastolic blood pressure) as well as the position used to elicit orthostatic hypotension (sitting to standing or lying to standing). The traditional procedure is to go from lying to standing, but some advocate that the action of sitting to standing better reflects how people normally rise and could be a more important indicator for risk of falls and adverse health outcomes.
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Juraschek SP, Daya N, Rawlings AM, Appel LJ, Miller ER, Windham BG, Griswold ME, Heiss G, Selvin E. Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults. JAMA Intern Med. Published online July 24, 2017. doi:10.1001/jamainternmed.2017.2937
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