Prevalence of initial orthostatic hypotension in geriatric inpatients: the role of time to stand.

PURPOSE: Initial orthostatic hypotension (IOH) is a clinically relevant blood pressure abnormality that remains underrecognised in older adults, particularly in hospitalised or frail populations. This study aimed to determine the prevalence of IOH in geriatric inpatients, compare clinical characteristics between individuals with and without IOH, and assess the diagnostic value of different measurement intervals.

METHODS

Continuous beat-to-beat blood pressure monitoring was used in geriatric inpatients. The test protocol included 5 min supine, 3 min standing, and 2 min recovery supine. Two diagnostic time windows were analysed: (1) within 15 s of the standing command, and (2) within 15 s after a stable upright posture. Clinical and demographic characteristics were compared between participants with and without IOH.

RESULTS

IOH was identified in 31.4% out of 137 patients (64% female; mean age 84 ± 6 years) when both diagnostic windows were considered. No statistically significant differences in clinical or demographic characteristics were observed between groups, although some non-significant trends, such as slightly longer hospital stay in the IOH group, were noted. The most pronounced blood pressure declines occurred within the first 30 s of the standing command (systolic: p = 0.005; diastolic: p < 0.001). The median time to achieve postural stability was 26.6 s.

CONCLUSION

IOH is common in geriatric inpatients, but often goes undetected due to its transient nature and delayed postural stabilisation, which affects diagnostic accuracy of traditional techniques. Continuous monitoring starting at the postural transition improves detection and may inform targeted interventions, particularly in high-risk patients, to reduce complications and optimise recovery.