Correspondence

Neurogenic Orthostatic Hypotension

N Engl J Med 2008; 358:2298May 22, 2008

Article

To the Editor:

In his Clinical Practice article on neurogenic orthostatic hypotension, Freeman (Feb. 7 issue)1 notes that the definition of orthostatic hypotension encompasses a drop in blood pressure during the first 3 minutes of standing. He states that when evaluating a patient, however, the blood pressure should be measured with the patient in the supine position and at least 3 minutes after the patient stands up. These two statements appear to contradict each other.

Mark Joy, M.D.
Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY 11209
mark.joy@va.gov

1 References

1. 1

   Freeman R. Neurogenic orthostatic hypotension. N Engl J Med 2008;358:615-624
   Full Text | Web of Science | Medline

Author/Editor Response

Orthostatic hypotension is defined by a consensus of experts as a reduction in systolic blood pressure of at least 20 mm Hg or a reduction in diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing. In clinical practice, to diagnose orthostatic hypotension, it is recommended that blood pressure be measured with the patient in the supine position and at least once when the patient has been standing for 3 minutes. More severe orthostatic hypotension may be diagnosed by measuring blood pressure within 3 minutes after standing. Delayed orthostatic hypotension may be diagnosed by measuring blood pressure after more than 3 minutes of standing.

Roy Freeman, M.B., Ch.B.
Harvard Medical School, Boston, MA 02115
rfreeman@bidmc.harvard.edu