# Orthostasis and Wide Pulse Pressure: Treat the Person

Pair postural BP with symptoms and timing; wide pulse pressure adds a vascular clue but does not supply a universal medication-stop threshold.

![Infographic: Orthostasis and Wide Pulse Pressure: Treat the Person](https://urinenephrology.org/visual-reference/images/orthostasis-pulse-pressure.png?v=20261003c)

## Measure the change

After supine rest, measure BP/pulse and repeat after standing, commonly at 1 and 3 minutes. A sustained SBP fall ≥20 or DBP fall ≥10 mmHg within 3 minutes defines conventional orthostatic hypotension. Record symptoms; a patient can be unsafe without meeting the numeric definition.

## Use timing and pulse as clues

Ask about morning, meals, heat, exertion, and medication changes. A blunted pulse response may suggest autonomic impairment or beta blockade; a larger rise can accompany depletion. Neither response is diagnostic alone. Consider anemia, infection, arrhythmia, and cardiac disease.

## Review reversible contributors

Assess dehydration, diuretic excess, alpha blockers, sedatives, vasodilators, and other medicines. Treat the cause while retaining important indications. Do not automatically stop all antihypertensives: uncontrolled hypertension and autonomic disease can coexist with standing hypotension.

## Adapt daily activity

Rise in stages, use support during symptomatic transitions, and consider physical countermeasures or compression when suitable. Salt/fluid expansion may help selected depleted patients but can harm HF or advanced CKD. Persistent syncope, injury, chest pain, or neurologic symptoms requires urgent assessment.

## Wide pulse pressure is a different signal

Pulse pressure = systolic minus diastolic BP. Arterial stiffness is common, but consider aortic regurgitation or high-output states when the examination suggests them. Treat overall cardiovascular risk and systolic hypertension while assessing symptoms and coronary perfusion concerns.

## Review outcomes after a change

Track falls, standing tolerance, daily function, home BP, and supine hypertension when relevant. A low DBP association with adverse outcomes does not by itself prove overtreatment. Use repeated symptoms and measurements to decide whether the target or regimen needs adjustment.

## Supporting evidence

- [Official clinical guidance](https://professional.heart.org/en/science-news/orthostatic-hypotension-in-adults-with-hypertension/top-things-to-know)
- [PubMed 30827125](https://pubmed.ncbi.nlm.nih.gov/30827125/)

## Source lessons

- [orthostatic hypotension](https://urinenephrology.org/2025_UDPA_Lectures_Live/hypertension/orthostatic-hypotension.html)
- [wide pulse pressure](https://urinenephrology.org/2025_UDPA_Lectures_Live/hypertension/wide-pulse-pressure.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.