Editing Orthostatic hypotension (section)

==Diagnosis==
Orthostatic hypotension can be confirmed by measuring a person's blood pressure after lying flat for 5 minutes, then 1 minute after standing, and 3 minutes after standing.<ref>{{Cite web|url=https://www.rcplondon.ac.uk/projects/outputs/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff|title=Measurement of lying and standing blood pressure: A brief guide for clinical staff|date=2017-01-13|website=RCP London|access-date=2019-09-23}}</ref> Orthostatic hypotension is defined as a fall in systolic blood pressure of at least 20 mmHg or the diastolic blood pressure of at least 10 mmHg between the supine reading and the upright reading.  Also, the heart rate should be measured for both positions.  A significant increase in heart rate from supine to standing may indicate a compensatory effort by the heart to maintain cardiac output. A related syndrome, [[postural orthostatic tachycardia syndrome]] (POTS), is diagnosed when at least a 30 bpm increase in heart rate occurs with little or no change in blood pressure. A [[tilt table test]] may also be performed.<ref name = "natale">{{cite journal | vauthors = Natale A, Akhtar M, Jazayeri M, Dhala A, Blanck Z, Deshpande S, Krebs A, Sra JS | display-authors = 6 | title = Provocation of hypotension during head-up tilt testing in subjects with no history of syncope or presyncope | journal = Circulation | volume = 92 | issue = 1 | pages = 54–58 | date = July 1995 | pmid = 7788917 | doi = 10.1161/01.CIR.92.1.54 }}</ref>

===Definition===
Orthostatic hypotension (or postural hypotension) is a drop in blood pressure upon standing.  One definition (AAFP) calls for a systolic blood pressure decrease of at least 20&nbsp;mm Hg or a diastolic blood pressure decrease of at least 10&nbsp;mm Hg within 3 minutes of standing.<ref name="pmid14705758">{{cite journal | vauthors = Bradley JG, Davis KA | title = Orthostatic hypotension | journal = American Family Physician | volume = 68 | issue = 12 | pages = 2393–2398 | date = December 2003 | pmid = 14705758 | url = https://www.aafp.org/afp/2003/1215/p2393.html }}</ref> A common first symptom is lightheadedness upon standing, possibly followed by more severe symptoms: narrowing or loss of vision, dizziness, weakness, and even syncope (fainting).{{citation needed|date=October 2021}}

=== Subcategories ===
Orthostatic hypotension can be subcategorized into three groups – initial, classic, and delayed.<ref name="Wieling_2007">{{cite journal | vauthors = Wieling W, Krediet CT, van Dijk N, Linzer M, Tschakovsky ME | title = Initial orthostatic hypotension: review of a forgotten condition | journal = Clinical Science | volume = 112 | issue = 3 | pages = 157–165 | date = February 2007 | pmid = 17199559 | doi = 10.1042/CS20060091 }}</ref><ref name="Moya_2009">{{cite journal | vauthors = Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, Deharo JC, Gajek J, Gjesdal K, Krahn A, Massin M, Pepi M, Pezawas T, Ruiz Granell R, Sarasin F, Ungar A, van Dijk JG, Walma EP, Wieling W | display-authors = 6 | title = Guidelines for the diagnosis and management of syncope (version 2009) | journal = European Heart Journal | volume = 30 | issue = 21 | pages = 2631–2671 | date = November 2009 | pmid = 19713422 | pmc = 3295536 | doi = 10.1093/eurheartj/ehp298 }}</ref><ref name="Gibbons_2006">{{cite journal | vauthors = Gibbons CH, Freeman R | title = Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance | journal = Neurology | volume = 67 | issue = 1 | pages = 28–32 | date = July 2006 | pmid = 16832073 | doi = 10.1212/01.wnl.0000223828.28215.0b | s2cid = 33902650 }}</ref>

Initial orthostatic hypotension is frequently characterized by a systolic blood pressure decrease of ≥40 mmHg or diastolic blood pressure decrease of ≥20 mmHg within 15 seconds of standing.<ref name="Wieling_2007" /> Blood pressure then spontaneously and rapidly returns to normal, so the period of hypotension and symptoms is short (<30 s).<ref name="Wieling_2007" />  Only continuous beat-to-beat BP measurement during an active standing-up maneuver can document this condition.<ref name="Wieling_2007" />

Classic orthostatic hypotension is frequently characterized by a systolic blood pressure decrease of ≥20 mmHg or diastolic blood pressure decrease of ≥10 mmHg between 30 seconds and 3 min of standing.<ref name="Moya_2009" />

Delayed orthostatic hypotension is frequently characterized by a sustained systolic blood pressure decrease of ≥20&nbsp;mm Hg or a sustained diastolic blood pressure decrease ≥of 10&nbsp;mm Hg beyond 3 minutes of standing or upright tilt table testing.<ref name="Gibbons_2006" />