title: The duration of the orthostatic blood pressure drop is predictive of death.
abstract: BACKGROUND
  Orthostatic hypotension (OH) affects 6% of community-dwelling older people. This increases to 60% when non-invasive, continuous blood pressure (BP) monitoring is used, due to identification of transient drops in BP which recover rapidly.
  
  
  OBJECTIVE
  To determine the clinical relevance of these transient orthostatic BP drops.
  
  
  METHODS
  Five-year clinical observational study.
  
  
  METHODS
  One hundred three consecutive new patients attending a Falls and Syncope Clinic in the UK from 1 February 2009 underwent continuous BP monitoring during an active stand. BP profiles were analysed to quantify all reductions in BP, measuring the duration of any drop below diagnostic criteria. Five-year follow-up data were extracted from hospital clinical records to assess clinical outcomes.
  
  
  RESULTS
  Systolic BP (sBP) dropped ≥20 mmHg in 76 (74%) individuals, with 65 (63%) having ≥10 mmHg drop in diastolic BP. However, only 22 (21%) cases were diagnosed clinically with OH. A sustained reduction in BP (≥30 s) had a sensitivity of 0.91 and specificity of 0.88 for a clinical diagnosis of OH, being more accurate than absolute BP reduction alone. A sustained reduction in sBP was associated with greater use of vasopressors (36%,P0.001) and an independent, significantly greater risk of death (45% at 5 years,P0.009).
  
  
  CONCLUSIONS
  An orthostatic reduction in sBP lasting ≥30 s improves accuracy of diagnosis. Moreover, given the significant adverse outcomes with a sustained reduction, clinicians should consider this when diagnosing and treating patients, as transient OH does not appear to be clinically significant.
authors.affiliation: From the NIHR Newcastle Biomedical Research Centre in Ageing and Chronic Disease, Newcastle upon Tyne Hospitals NHS Foundation Trust and james.frith@newcastle.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Frith
authors.affiliation: The Medical School, Newcastle University, Newcastle upon Tyne NE1 4LP, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Bashir
authors.affiliation: From the NIHR Newcastle Biomedical Research Centre in Ageing and Chronic Disease, Newcastle upon Tyne Hospitals NHS Foundation Trust and.
authors.forename: J L
authors.initials: JL
authors.lastname: Newton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011187:Posture; D012372:ROC Curve; D012307:Risk Factors; D006113:United Kingdom; D055815:Young Adult