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2022 surveillance of hypertension (NG136) and transient loss of consciousness (CG109) guidelines for postural hypotension

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Background

We received an enquiry highlighting a potential diagnosis accuracy issue with recommendations in the NICE guideline on hypertension (NG136). The guideline recommends initial measurement of blood pressure either in the seated or supine position in people with symptoms of postural hypotension (falls or postural dizziness). The recommendation then requires that blood pressure is measured again with the person standing for at least 1 minute before measurement. This is to establish if the systolic blood pressure falls by 20 mmHg or more when the person is standing. The enquirer stated if blood pressure was measured in the sitting (rather than the supine position), followed by the standing position, a significant proportion of postural hypotension cases may be missed, particularly in older and frail people.

We reviewed this issue to establish whether the guideline should be updated. We also considered all NICE guidelines which cover postural hypotension or 'orthostatic hypotension' to check they are consistent and clear.