Intended for healthcare professionals

Practice Clinical updates

Postural hypotension

BMJ 2021; 373 doi: (Published 23 April 2021) Cite this as: BMJ 2021;373:n922
  1. Artaza Gilani, honorary lecturer, general practitioner in north west London1,
  2. Stephen P Juraschek, assistant professor of medicine2,
  3. Matthew J Belanger, senior resident physician2,
  4. Julie E Vowles, consultant in acute and geriatric medicine3,
  5. S Goya Wannamethee, professor of epidemiology1
  1. 1UCL Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Hospital Campus), London NW3 2PF, UK
  2. 2Harvard Medical School, Beth Israel Deaconess Medical Center, Division of General Medicine, Section for Research, Boston, MA 02215, USA
  3. 3Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
  1. Correspondence to: Artaza Gilani artaza.gilani{at}

What you need to know

  • Postural hypotension is a drop in blood pressure (≥20 mm Hg systolic and/or ≥10 mm Hg diastolic) that occurs within 3 minutes of standing

  • Test for it in people who have symptoms of lightheadedness or dizziness on changing from lying or sitting to standing posture or those with an unexplained fall

  • Age over 60 years, diabetes, Parkinson’s disease, and certain medications increase the risk

  • The aim of treatment is to reduce symptoms (including risk of injury) and improve quality of life, rather than trying to reduce the postural drop in blood pressure

  • Evidence for both non-pharmacological and pharmacological interventions is poor, making it important to identify why a patient has postural hypotension and to address the underlying condition

Postural hypotension, also called orthostatic hypotension, is an abnormal drop in blood pressure on standing. It impairs quality of life and increases risk of falls, cardiovascular disease, depression, dementia, and death.1234 Early detection in patients with symptoms or certain risk factors may prevent some of these complications. Current guidelines for detecting and managing postural hypotension are varied and based on limited evidence. Primary care providers play an important role in screening and detection of postural hypotension and in helping patients make shared treatment decisions to improve symptoms and reduce risk.

Sources and selection criteria

We searched Embase, Medline, the Cochrane Central Register of Controlled Trials, and Web of Science using the terms “orthostatic hypotension,” “postural hypotension,” “orthostatic intolerance,” and “postural intolerance.” We also used personal archived references, which included our published work and National Institute for Health and Care Excellence (NICE) guidelines.

How common is it?

The prevalence of postural hypotension increases with age. One in five community-dwelling adults over 60 years old and one in four people in long term residential care have postural hypotension, as per a systematic review and meta-analysis (26 studies, >25 000 people).5 Two large …

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