Should primary care patients be screened for orthostatic hypotension?

BACKGROUND

Primary care physicians test for orthostatic hypotension to find risk factors they can modify. By doing so, they may prevent adverse outcomes related to falls and ischemic organ injury due to hypoperfusion. Varied recommendations have been made regarding which patients to test, measurement methods, and the definition of a clinically significant postural decline in blood pressure.

METHODS

We identified research articles relating to orthostatic hypotension by doing a literature review. Eleven articles were selected on the basis of quality of research methods and applicability to primary care practice from which prevalence, associated factors, and outcomes related to orthostatic hypotension were reported.

RESULTS

The prevalence of orthostatic hypotension varied from 13% to 30.3% in elderly patients. Hypertension was the most consistently associated diagnosis. Two of 3 studies did not find an association between orthostatic hypotension and mortality, and the third found that association only in patients with diabetes and hypertension.

CONCLUSIONS

The information available does not support postural blood pressure testing as a screening device among patients attending primary care practices. However, there is evidence to support the testing of high-risk subgroups of patients. Answers to the proposed research questions will clarify how testing for orthostatic hypotension can be most effectively applied in primary care.