Abstract
Introduction:
Postural hypotension (PH) is a significant predictor of mortality and is associated with increased risk of falls, functional decline and hospital admission among elderly patients. The National Institute for Health and Care Excellence (NICE) recommends routine assessment of PH in patients presenting with falls alongside a comprehensive review of contributing factors such as medication and hydration.
This audit aims to evaluate current practice in the diagnosis and management of PH for patients presenting to Frimley Park Hospital’s Frailty Same Day Emergency Care (SDEC) against NICE guidelines (NG249); Falls assessment and prevention in older people.
Methods:
A retrospective analysis of comprehensive geriatric assessment (CGA) documentation was conducted over six months, from October 2024 to March 2025. This audit included patients referred to Frailty SDEC following a fall who were assessed and discharged by the frailty team; patients admitted to hospital post assessment were excluded.
Results:
83 patients presented following a fall. 84% had lying and standing blood pressure (BP) measured. Of 70 patients assessed for PH, 39% (27) showed a postural blood pressure drop. Further blood pressure readings at 1 and 3 minutes of standing were measured in 74% of these patients. Symptoms such as dizziness upon standing were documented in all cases, with 37% of patients displaying symptomatic PH.
Medication reviews were completed for all patients resulting in deprescription of medications contributing to PH in 44% of patients. Additionally, 15% of patients were commenced on midodrine.
11% patients received compression stockings. 44% were given some form of non-pharmacological advice. Most patients were encouraged to increase oral fluid intake, while exercise advice was documented in 19% and PH information leaflets provided to only 7%.
Conclusions:
Adherence to PH assessment guidelines, particularly BP measurements and medication review is good however, non-pharmacological management and patient education is inconsistent and should be standardised.
Comments
Postural hypotension assessment
Hello. Thank you for presenting your work on postural hypotension. Did patients that had Lying and Standing Blood pressures without a documented blood pressure drop just have their blood pressure on immediate standing or did they also have blood pressure checked at 1 minute and 3 minutes of standing? How do you propose to standardise management?
Thank you for your poster,…
Thank you for your poster, was there any correlation between symptom severity and advice given or differences between who was conducting the tests?
PH information poster
Is there a link where we can view information on PH information leaflets?
Links to PH information leaflets
Thank you for your comment. Unfortunately I'm not sure how to add a link to the comments section. I have tried to add a link below however alternatively you can find this leaflet on the BGS website titled 'Information for patients with dropping blood pressure (orthostatic hypotension)'
Dropping Blood Pressure.pdf