Orthostatic hypertension in hypertensive patients: should we bother?

Although we were taught in medical school that blood pressure should be measured in different body positions, particularly in older patients, an active standing test, in which blood pressure and heart rate are taken in supine, seated, and standing positions, is rarely done. Clinical trials, hypertension guidelines, and daily practice have over many years relied on office blood pressure measurement in the sitting position. Seated blood pressure is a well established cardiovascular risk marker, as evidenced by multiple epidemiological surveys and hypertension trials. However, important clinical information may be lost when we ignore the dynamic blood pressure response to changes in posture, which occurs many times during the day.

In a linked study (doi:10.1136/bmj-2024-080507), Juraschek and colleagues report results of a systematic review of interventional trials in hypertension assessing the effect of antihypertensive therapy on occurrence of orthostatic hypertension—that is, a distinct rise in blood pressure on standing.1 The question is relevant because initial studies have suggested that antihypertensive drugs might promote orthostatic hypertension by reducing blood volume and venous return.2 But why bother about orthostatic hypertension at all?

When one changes body position from supine to …