BP LogOrthostatic hypotension check
Compare a lying or sitting reading with standing readings at 1 and 3 minutes to see whether the drop meets the 20/10 mmHg orthostatic threshold.
Compare lying or sitting with standing
Rest for 5 minutes and measure, then stand and measure again at 1 minute and 3 minutes. Have someone with you, and sit straight back down if you feel faint.
Enter the first reading and at least one standing reading.
A drop is the first reading minus the standing one, so a positive number means pressure fell. Fainting, falls or dizziness every time you stand are worth telling your doctor about whatever the numbers say.
What the check looks for
When you stand, blood pools in your legs and your body tightens blood vessels and speeds up your heart to keep pressure steady. If that response falls short, pressure drops and you may feel dizzy or lightheaded. Clinicians call this orthostatic hypotension. Common causes include dehydration, some blood pressure and prostate medicines, long bed rest, and conditions affecting the nerves that control blood vessels.
How to do it
- Lie flat (or sit) and rest quietly for 5 minutes with the cuff on. Measure.
- Stand up with your helper steadying you, and keep your cuffed arm supported at heart level.
- Measure again at 1 minute and at 3 minutes after standing. Note any symptoms.
Our orthostatic test guide walks through the safety steps in detail.
How it is calculated
For each standing reading, the drop is the first reading minus the standing reading, so a positive number means pressure fell. The result is consistent with orthostatic hypotension when the top number falls by 20 or more or the bottom number by 10 or more at either time point. The pulse rise is standing pulse minus first pulse, flagged at 30 bpm or more. These thresholds come from the consensus definition, applied by the shared code library behind the BP Log apps.
Common questions
What counts as orthostatic hypotension?
A drop of at least 20 mmHg in the top number or at least 10 mmHg in the bottom number within 3 minutes of standing, compared with lying down. Either one is enough.
Is it safe to test at home?
Only with someone beside you and a chair or bed directly behind you. Sit or lie down straight away if you feel lightheaded, and do not test at home if you have fainted or had unexplained falls; talk to your doctor instead.
Can I do the test sitting instead of lying down?
Yes, and many people do because it is gentler. Lying to standing produces bigger changes, so it is the more sensitive test, and a sitting to standing check can miss a smaller drop.
What does a pulse rise of 30 or more mean?
A rise of 30 beats per minute or more on standing, without a big drop in blood pressure, is part of how postural orthostatic tachycardia syndrome (POTS) is defined. It is diagnosed with symptoms and testing by a clinician, not from one home check.
- Orthostatic Hypotension: A Practical Approach (American Family Physician, Kim and Farrell, 2022): A drop of 20 systolic or 10 diastolic within 3 minutes of standing; 5 minutes lying down first; lying to standing is more sensitive than sitting to standing
- Freeman R, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome (Clinical Autonomic Research, 2011): Consensus definitions: orthostatic hypotension as a sustained drop of 20 systolic or 10 diastolic within 3 minutes of standing; a pulse rise of 30 bpm or more as part of the POTS definition
- Muntner P, et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association (Hypertension, 2019): How to measure; home protocol of 2 readings a minute apart, morning and evening, for 7 days; cuff sizes by arm circumference; white coat and masked hypertension definitions; home 130/80 corresponds to office 130/80
The free iPhone app times two readings a minute apart, averages them, keeps your morning and evening numbers apart, and builds a report for your doctor.
Other ways to track: desktop, Excel and printable logs