Understanding Measurement of Postural Hypotension: A Nationwide Survey of Primary Care Practice in England

Abstract

Objective: Postural hypotension (PH), the drop in blood pressure (BP) on standing, is associated with falls, all-cause mortality and cognitive decline. PH diagnostic criteria require lying-to-standing BP measurements. PH is common, with prevalence estimated at 19% in older primary care patients, yet it is infrequently (<1%) recorded in routine English primary care data, suggesting PH testing and/or recording is under-utilised in this setting; reasons for such limited PH testing and/or recording have not yet been explored in detail. The aim of this study was to understand current PH measurement and management strategies in primary care practices across England. Design and method: Clinical Research Networks circulated an online survey to primary care staff involved in measurement of BP from 10th August until 8th December 2022. Responses were summarised as percentages and/or median (inter-quartile ranges (IQR)) and chi2 tests. Modelling is underway to explore response variations according to professional and practice characteristics. Final analyses will be presented at the conference. Results: Replies from 703 practitioners in 242 practices were received; predominantly from doctors (51%), nurses (28%) and healthcare assistants (HCAs; 11%), plus pharmacists, paramedics and other roles; median age 45 (IQR 38 to 53) years, 72% female. Overall, doctors (97%) and nurses (92%) reported checking for PH more often than HCAs (82%) or pharmacists (80%; p < 0.001). They all usually check when symptoms are present (97%). Other reasons for checking - patients aged over 80 years (24%); hypertension reviews (17%); medication reviews (12%) or diabetes reviews (11%) – were all more commonly undertaken by allied health professionals than by doctors (p < 0.001). Standing BP measurements are regarded as feasible, usually (77%) following sitting; only 22% use lying-to-standing measurements. 64% observe a rest period (median 5 (2 to 5) minutes) before sitting or lying measurements and 1 (IQR 1 to 2) standing BP measurements are made, usually (66%) within the first minute of standing. Conclusions: Findings suggest that most PH assessments in primary care do not meet current guideline criteria. Results from this survey will inform future national guidelines to support PH detection.