Orthostatic blood pressure test at home: how to check safely

Orthostatic hypotension means your blood pressure falls by at least 20 points systolic (the top number) or at least 10 points diastolic (the bottom number) within three minutes of standing up. You can check for it at home with an upper-arm cuff, a timer, and a second person in the room: lie down for five minutes and measure, then stand and measure again at 1 minute and 3 minutes.

In a clinic, this check is called orthostatic vital signs (or "orthostatics"): blood pressure and pulse measured lying down, then again after you stand. That's the textbook version, as described in American Family Physician (AAFP) and the Merck Manual. At home, the main extra job is not ending up on the floor.

Safety first

The test is designed to provoke the thing you're worried about, which is a drop in blood pressure when you stand. So set it up like that might happen.

• Have someone with you. They should stand right next to you, close enough to steady you, and they can work the cuff and the timer.
• Clear the space. Keep a chair or the bed directly behind you so you can sit straight back down.
• Stop if you feel faint. If you get lightheaded, your vision greys out, or you feel sweaty or sick, sit or lie down right away. The reading can wait, and a fall is the one outcome you're trying hard to avoid.
• Don't do this at home if you've fainted or had unexplained falls. Talk to your doctor first. AAFP's review notes that when someone can't stand safely, a tilt table test in a lab is the recommended route, and fainting or an unexplained fall is a reason for proper evaluation anyway.

How to do the test

You'll need an upper-arm monitor that also shows pulse, a timer, and your helper.

While you're standing, have your helper support your arm at about heart level so the cuff position stays the same as it was lying down. Write down the time, which arm you used, and how you felt at each step. If you got dizzy, note when.

The sitting-to-standing version

Lying down for five minutes isn't always practical, so many people (and many apps) use a sitting-to-standing version instead. It's gentler and easier to do. The trade-off is sensitivity: AAFP's review points out that going from lying to standing produces the biggest changes in blood pressure and heart rate, so it's the more sensitive test. A sitting-to-standing check can miss a smaller drop.

If your sitting-to-standing numbers look normal but you keep getting dizzy when you stand, tell your doctor anyway.

Reading your numbers

Subtract the standing reading from the lying (or sitting) reading. Either threshold counts.

Check both the 1-minute and 3-minute readings. AAFP's review cites a large study in which a drop that showed up within the first minute of standing was linked to falls, fractures, fainting, and death in people aged 45 to 64.

Timing can vary. The same review describes an "initial" form, where the drop happens in the first 15 seconds and recovers, and a "delayed" form that appears after 3 minutes. A home test that looks normal at 3 minutes doesn't cover either of those.

Why your pulse matters

When blood pressure drops, the heart normally speeds up to compensate. The Merck Manual notes that a rise of less than 10 beats per minute suggests a problem with the autonomic nervous system, the automatic wiring that adjusts blood pressure and heart rate. A big jump points elsewhere, such as low fluid volume. You don't need to interpret this yourself. Just write the pulse down every time, because it helps your doctor figure out the cause.

A single test is one snapshot. Blood pressure moves around for lots of reasons (more on that in why blood pressure is different every time), so bring the numbers and your symptoms to your doctor instead of drawing conclusions from one morning.

Common causes, in plain words

AAFP puts the prevalence at about 5% of middle-aged adults and about 20% of people 60 and older. The usual causes, drawn from AAFP and Cleveland Clinic:

• Not enough fluid in the tank. Dehydration from vomiting, diarrhea, not drinking enough, or diuretics (water pills). Blood loss does the same thing.
• Medications. Blood pressure medicines, some heart medicines, antidepressants, opioids, and drugs for Parkinson disease are among the common ones.
• Problems with the automatic nervous system. Parkinson disease, multiple system atrophy, and nerve damage from diabetes can all blunt the reflex that tightens blood vessels when you stand.
• Prolonged bed rest. After days in bed, the body gets out of practice at standing up.
• Other conditions. Anemia, heart rhythm problems, and heart failure.

If you think a medication is behind it, don't stop or skip it on your own. Bring your readings and your medication list to your doctor. The NHS notes that a doctor may change the medicine or the dose if it turns out to be the cause, and that decision belongs with them.

How this differs from POTS

POTS (postural orthostatic tachycardia syndrome) also causes symptoms on standing, which is why the two get mixed up.

Those POTS criteria come from AAFP's review. The 10-minute window means a 3-minute home check can't rule POTS in or out. Cleveland Clinic describes a tilt table test as the main way POTS is diagnosed. If your blood pressure holds steady but your pulse climbs a lot and you feel awful standing, that's worth raising with your doctor.

When this needs a doctor promptly

Cleveland Clinic advises seeking care right away for any of these:

• Fainting, even briefly
• A fall
• Chest pain
• Trouble with balance
• Signs of shock

For chest pain, fainting, or new weakness, numbness, or trouble speaking, call 911 or your local emergency number rather than driving yourself.

For dizziness that keeps happening when you stand, without those warning signs, book a regular appointment. The NHS and Cleveland Clinic both say repeated dizziness or fainting is a reason to see your doctor.

Common questions

Is it normal to feel a little lightheaded when I stand up fast?

A brief head rush that passes within seconds is common, and AAFP's review describes this kind of very early drop as its own category. If it happens often, lasts longer, or ever makes you faint, mention it to your doctor.

Should I test before or after my blood pressure pills?

Keep your usual routine. Write down when you took your medicines relative to the test, and ask your doctor if they want it done at a particular time.

My numbers were normal, but I still get dizzy standing. Now what?

Tell your doctor. A delayed drop after 3 minutes, a sitting-to-standing test missing a smaller drop, POTS, and causes unrelated to blood pressure are all possibilities that need a proper look.

Can I share the results with my doctor?

Yes, and you should. Bring the lying and standing numbers, the pulse at each step, the times, and your symptoms. The same habits apply as with any home log; see sharing home blood pressure readings with your doctor.

How BP Log helps

BP Log includes a guided sitting-to-standing orthostatic check that records your sitting and standing blood pressure and pulse, so the numbers are saved with a time stamp instead of on a sticky note. Lifetime adds orthostatic trends over time. Because it uses the sitting-to-standing method, mention any dizziness to your doctor even when the result looks normal.