In the clinical evaluation of a patient with a previous transient loss of consciousness, measurement of laying down and standing blood pressure cannot be omitted in order to exclude orthostatic hypotension.

Type of practice

Other health practices

Topic Area

Neurology

Orthostatic hypotension is defined as a decrease in systolic blood pressure ≥ 20 mmHg and in diastolic blood pressure ≥10 mmHg after 3 min of standing. Frequently the patients will tolerate this condition – as orthostatic intolerance is not constantly reported – therefore it must be investigated.If orthostatic hypotension is diagnosed and related to transient loss of consciousness, some other causes must be excluded: cardiological and neurological diseases or pharmacological treatments such as diuretics, alpha-blockers, beta-blockers, calcium channel blockers, tricyclic antidepressants, levodopa and antipsychotics.
Orthostatic hypotension identification offers the opportunity of treatment and – if possible – of prevention measures.

Sources

1. NICE National Institute for Health and Clinical Excellence. Transient loss of consciousness (‘Blackouts’) Management in adults and young people. London: Royal College of Physicians (UK); 2010:11, 18, 20, 24.
2. The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009; 30(21):2647.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.