Hypertension and hypotension: getting the balance right

POSTURAL HYPOTENSION

Postural hypotension (PH) is defined as a reduction in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing or head-up tilt to at least 60 degrees on a tilt table.¹ Recognition of PH is important because, whether symptomatic or not, it is associated with adverse outcomes such as falls, mortality, or cognitive impairment.

The expected prevalence of PH among older adults is around 20% in primary care and higher in residential settings.² We have previously noted that primary care records appear to suggest a much lower prevalence of PH in English primary care (unpublished Clinical Practice Research Datalink GOLD observations from 9 million linked records found only 95 000 records of patients with PH, equating to approximately 1% prevalence [Payne R, personal communication, 2020]). Cini Bhanu and colleagues set out to explore this paradox of missing cases using anonymised electronic primary care records for >18 million patients from >700 practices, in a sample broadly representative of UK practices.³ In this large retrospective cohort study they found a new diagnosis of postural hypotension for 24 973 of 2 911 260 patients …