Understanding the measurement of postural hypotension in primary care - UMPH

A drop in blood pressure when a person moves from a sitting or lying position to standing up is called “postural hypotension”. Postural hypotension is associated with complications such as memory problems, falls, and an increased risk of early death. Dealing with these problems is a huge expense to the NHS. The risk of them occurring can be reduced if postural hypotension is identified early, so that relevant treatments and preventative measures can be taken.

We know from previous research that postural hypotension is common, affecting as many as 1 in 5 of the older (65 years of age or above) primary care population. However, an examination of UK primary care medical records shows that only 1% of primary care patients have a recorded diagnosis of postural hypotension. This difference between expected and recorded numbers suggests a lack of testing, diagnosis and/or recording of the condition in primary care.

Doctors and nurses generally only check for postural hypotension if a person reports symptoms, such as feeling dizzy on standing. More than half of people with postural hypotension do not, in fact, have these symptoms but are still at risk of falls and other problems. This means many are unlikely to be detected, perhaps due to doctors and nurses lacking awareness of the problem or having high workloads.

Postural hypotension is usually checked for in primary care by asking the person to stand from a sitting position. Experts advise that it should be checked on standing up from a lying position. This difference means that not all people with postural hypotension may be picked up properly, therefore, they may remain at risk of important complications that could be prevented.

How often postural hypotension occurs, how it is detected, who is checking for it, and who is being checked, in UK primary care settings is therefore unclear. In this study, we aim to understand more about current approaches to measuring postural hypotension in primary care, and to develop practical guidance to improve postural hypotension detection in the future.

We will do this by:

1) undertaking a national survey of primary care staff to find out what they are currently doing to assess their patients for postural hypotension

2) interviewing primary care doctors and nurses to understand why they check, or do not check for postural hypotension.
The survey will be distributed online and interviews undertaken via telephone or video calls over a 15 month period.

Our results will help doctors and nurses to understand how best to check for postural hypotension in daily practice. We hope this will enable people with postural hypotension to be identified more easily and to be offered appropriate treatment to reduce their risk of harm.

Amount Awarded: £130,187