Core IM | Internal Medicine Podcast #187 Orthostatic Hypotension Part 1: Gray Matters Segment
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Sep 11, 2025 Discover the intricacies of diagnosing and managing orthostatic hypotension, especially in the elderly. Learn about the importance of multiple blood pressure readings and contextual patient factors. The podcast highlights innovative non-pharmacologic strategies like hydration techniques and the use of compression garments. It also discusses the significance of tailored treatment approaches and encourages listener engagement in sharing their experiences. Tune in for practical insights that prioritize patient functionality over mere blood pressure numbers.
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Case: Urinary Retention Uncovers Orthostasis
- A 72-year-old with severe urinary retention and A1c 12.5% developed persistent lightheadedness despite fluids and cath drainage.
- His orthostatic hypotension persisted after diuresis resolved, prompting further evaluation for autonomic dysfunction.
Definition Tied To Clinical Harm
- Orthostatic hypotension is defined as a ≥20 mmHg systolic or ≥10 mmHg diastolic drop on standing and links to dizziness, falls, MI, and cognitive decline.
- These thresholds were chosen because drops of this size associate with clinically meaningful harm.
How To Measure Orthostatic Vitals Correctly
- Measure orthostatic vitals after the patient is supine for ≥5 minutes and get at least two supine readings for stability.
- Obtain blood pressure and heart rate at 1 and 3 minutes after standing, and extend to 5–10 minutes if suspicion remains high.