In addition to the mean/median differences in BP, we explored the variability across positions in terms of the percentage of subjects with large variations (≤ or ≥10mmHg) for each of the six comparisons (Table 3). Notable differences have been observed between sitting and supine blood pressures, 1 and human bodies spend one-third of the time in the supine position. "And that calls for a mechanism that can instantaneously constrict the veins and divert the blood to where we want it to go," Dr. Osborne says. How to measure lying and standing blood pressure and why it is important for our patients. "But it could also simply be a sign of age," he says. Hypertension affects hundreds of millions of subjects worldwide and currently represents a major public health issue in the agenda of all developed countries.1,2 Both for the identification and clinical management of hypertensive subjects, the measurement of blood pressure (BP) is a crucial practice. Several studies compared BP values when measured in sitting or supine positions, reporting variations which ranged from 0 to a maximum of 10mmHg.5,7,9,23,–25 In most studies, the average SBP was higher when measured in supine than sitting position,9,17,24,26 whereas the mean DBP was usually highest in sitting position.7,8,23,27 Our sample of hypertensive subjects showed the same trends for SBP and DBP, although the differences in SBP9,17,26 and DBP7,23,27 across positions were generally smaller that in most previous studies.7,8,9,17,23,24,26,27. How To Take Orthostatic Blood Pressure Measurements 1. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. 2.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JLJr, Jones DW, Materson BJ, Oparil S, Wright JTJr, Roccella EJ. Leaf Group Ltd. Without blood pressure, our body would not receive the oxygen and nutrients it needs to … 5.Jamieson MJ, Webster J, Philips S, Jeffers TA, Scott AK, Robb OJ, Lovell HG, Petrie JC. These findings suggest a lower BP variability at the second and third measurements, and seem to support JNC guidelines recommending only the second and third of three readings be considered.28, Finally, this study was not designed to elucidate the physiological mechanisms underlying the observed variation in BP according to body position. used as a substitute for professional medical advice, Effects of body position on blood pressure Blood pressure is commonly measured in the seated or supine position; however, the two positions give different measurement values. By contrast, DBP increased of 1.8 and 2.9mmHg, respectively (both P < 0.001). Previous studies indicated the change in hydrostatic pressure as the main cause;26,27 however, one or more unknown factors may also play a role in determining BP variability.29 In example, the change of body position produces a decrease in venous return and a resultant drop in cardiac output as blood accumulates in the lower extremities and in the abdominal vasculature (from supine to Fowler position).30. Three measurements were made in each of the main positions: sitting (with the arm supported on the table at the right atrial level); supine (arm supported by a pillow at the heart level); and Fowler's (bed back at 45°, and the arm resting on the bed supported by a heart-level pillow). In fact, everyone will likely experience this kind of dizziness, at least to a mild degree, as they age, which is why we always tell our more mature patients to be careful not to get up out of a chair or bed too quickly. Though the process almost always unfolds seamlessly and in the blink of an eye, that's not always the case. 22.Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. We also fit two random-effect regression models, with smaller standard errors but no appreciable differences in coefficients and P values, and conservatively opted to show generalized estimating equations results only. It has been shown to decrease spasticity in children with cerebral palsy.4 It also lessens spasticity in individuals wit… The nine BP measurements were made in different order and in different positions. The influence of supine rest on the blood pressure response to standing and 70" head-up tilt was studied in detail for the first 30 s after the change of posture. Current guidelines suggests that BP can be measured indifferently in supine or sitting position,3,4 although it has been repeatedly documented that diastolic (DBP)5,–7 and, less convincingly, systolic (SBP)8 BP can be higher if measured in sitting position.4,9 Given that the differences between supine and sitting BP have been found to be relatively small,4,9 health professionals commonly do not consider or underestimate the effect of position when interpreting the results of BP measurements. Gravity is your friend. For example, you may suffer from a condition called orthostatic hypotension (or postural hypotension), which the Mayo Clinic describes as a form of low blood pressure that strikes specifically when you stand up from a seated or supine position. of DBP = 10mmHg, regardless of the position. Supine and sitting systolic blood pressures were not different, but they were different from standing blood pressure (P < 0 Exercise intervention to Normalize blood pressure and nocturnal Dipping in HyperTensive patients (END-HT): protocol of a randomized controlled trial, Risk of Incident Hypertension According to Physical Activity and Temporal Changes in Weight, Salt intake, aldosterone secretion and obesity: role in the pathogenesis of resistant hypertension, Renal sodium handling: perspective on adaptation to clinical practice, Associations between Social Determinants and Hypertension, Stage 2 Hypertension and Controlled Blood Pressure among Men and Women in the US, http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf, http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm, Receive exclusive offers and updates from Oxford Academic. Therefore, the bias caused by the inclusion of obese individuals did not seem to relevantly alter the results of the study. Copyright © 3.Ramsay L, Williams B, Johnston G, MacGregor G, Poston L, Potter J, Poulter N, Russell G. 4.Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Moreover, although it may be expected given that these variables do not change across measurements, the results of the multivariate analysis did not change when also BMI, age, gender, use of diuretics, and β-blockers were included in the model. In addition, they said diastolic blood pressure is 1-5 mmHg higher when measured supine vs seated 8. Fowler's position may represent a valid alternative to sitting and supine positions for BP measurement in routine clinical practice. The treatment of high blood pressure (hypertension) with medications in these patients may actually lead to an excessive fall in BP with standing. d'Annunzio” of Chieti, Clinical Research Center, Ce.S.I., University “G. Moreover, we do not select every advertiser or advertisement that appears on the web site-many of the Take the blood pressure and pulse, recording the numbers and identifying them as “lying down.” 3. Predictors of hypertension detection in English general practices: a cross sectional study. The percentages of subjects with large variations in DBP was lower; the highest being 20.4% in sitting position (38.0% considering all positions). To explore whether the appearance of large differences could be associated with the order of the measurement, both comparisons by position and by order were repeated using order categories (Table 3). For 6h before test (or during the night if the test was in the morning), participants were requested not to drink more than two “normal” glasses of water. Most guidelines for management of hypertension do not give special preference to a specific position of patient during blood pressure (BP) measurement, suggesting that BP readings taken with patients sitting, supine and standing are equivalent. "If it's very severe or a repeating issue, there may be something going on that needs to be checked out," Dr. Osborne says. However, even a mean difference of a few millimeters of mmHg may have relevant implications,10 because those individuals with larger differences in BP as measured in supine or sitting position may be at risk of substantial changes in their therapeutic history according to the position of the measurement.4 As an example, an individual's BP may have been measured in sitting position before therapy and in supine position thereafter, and the effect of the therapy might therefore be overestimated (or vice versa), leading to therapeutic strategies that might be inaccurate or even incorrect. It keeps you, and everything around you, from simply floating off into space. This is the position in which the person’s heart is not under any kind of stress and the heartbeat is normal. The body mass index (BMI) was then computed as the rate between weight in kilograms and the square of the height in meters. OH increases the risk of … advertisements are served by third party advertising companies. Diastolic pressure is the force of the blood against the artery walls when your heart is not contracting (at rest /between beats). Thus, a more precise quantification of the differences in BP according to the body position, especially for those subjects in active hypertensive treatment, may be of extreme interest to support operators in their interpretation of BP measurement results. The mean DBPs showed an opposite trend: it was highest in sitting position (83.0 ± 9.6mmHg); intermediate in Fowler's (81.9 ± 9.4mmHg), and lowest in supine (80.1 ± 9.1mmHg). Table 3 also shows the proportions of subjects with large differences in BP according to the order of the measurement. Nine measurements were taken: three measurements, in random order, in supine, Fowler's, and sitting position. Global Strategy on Diet, Physical Activity and Health, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Therefore, in the clinical management of hypertensive subjects, if BP is measured before therapy in one position and after therapy in another position, the clinician may opt for imprecise or incorrect therapeutic strategies in a relevant proportion of subjects. But not to worry: "There's actually a very complex mechanism to take care of that," he explains. No differences in BP were observed according to heart rate. The variability of mean BP by position was evaluated in six comparisons: supine vs. Fowler's; supine vs. sitting; Fowler's vs. sitting (for both SBP and DBP). In addition to BP, the following variables were measured by the nurse: height (bare foot) and weight (underwear), heart rate (which is automatically measured by the oscillometric device during each BP measurement), and arm circumference (naked arm). The strengths of the study are the high number of measurements for each subjects, the use of the same validated instrument for all BP recordings, finally the random order of every BP measurements. Concerning SBP, almost one-third of the sample showed a large difference in at least one comparison (first vs. second measurement; first vs. third; and/or second vs. third) regardless of the position. Standing has been shown to delay the appearance of contractures and improve those that already exist.2,3For individuals who lack the strength to stand, the standing frame keeps them in a good position to stretch their lower extremity and trunk muscles for extended periods. Discussion of positional changes in blood pressure using a diagram from the HeartPhys iPad app (now on the App Store at http://appstore.com/heartphys ) Still, if you start to experience these symptoms with increasing frequency, it could be a sign of a number of serious underlying conditions, the Mayo Clinic warns, which may include heart and endocrine problems or nervous system disorders such as Parkinson's disease. Then, mean/median differences have been computed for each of the six comparisons: mean supine vs. mean Fowler's; mean supine vs. mean sitting; Fowler's vs. sitting (for both SBP and DBP). Giancarlo Cicolini, Carmine Pizzi, Elisabetta Palma, Marco Bucci, Francesco Schioppa, Andrea Mezzetti, Lamberto Manzoli, Differences in Blood Pressure by Body Position (Supine, Fowler's, and Sitting) in Hypertensive Subjects, American Journal of Hypertension, Volume 24, Issue 10, October 2011, Pages 1073–1079, https://doi.org/10.1038/ajh.2011.106. Blood pressure can be categorized as sitting, supine, or orthostatic according to the position of measurement. 27.Netea RT, Bijlstra PJ, Lenders JW, Smits P, Thien T. 29.Kato T, Kikuya M, Ohkubo T, Satoh M, Hara A, Obara T, Metoki H, Asayama K, Hirose T, Inoue R, Kanno A, Totsune K, Hoshi H, Satoh H, Imai Y. The mean supine, sitting, and standing blood pressures were 146 ± 15 91 ± 7, 144 ± 15 96 ± 8, and 149 ± 17 103 ± 7 mm Hg, respectively. The average SBPs were 139.3 ± 14.0; 138.1 ± 13.8, and 137.2 ± 13.7mmHg in supine, Fowler's, and sitting position, respectively. The authors declared no conflict of interest. Inclusion criteria were: age >18 years; previously (at least 3 months before) diagnosed essential hypertension by a cardiologist according to current guidelines;4,18 active treatment for hypertension; provision of signed informed consent. Specific tables were created containing a computer generated random sequence of each position, and a different random table was used for each patient. The blood Pressure can also be measured at the time of standing. In patients with chronotropic incompetence, heart rate may not increase upon standing, and they may experience orthostatic hypotension (OH). We cannot exclude that some other participants had Parkinsonism in early stages or autonomic dysfunction, as our visits were not focused on neurological disorders, however it seems unlikely that these issues relevantly biased the overall results. National Heart, Lung, and Blood Institute, Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Guidelines for management of hypertension: report of the third working party of the British Hypertension Society, Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research, The measurement of blood pressure: sitting or supine, once or twice, Does it matter whether blood pressure measurements are taken with subjects sitting or supine, Office blood pressures in supine, sitting, and standing positions: correlation with ambulatory blood pressures, Effect of Fowler's body position on blood pressure measurement, Influence of body and arm position on blood pressure readings: an overview, Prognostic value of different indices of blood pressure variability in hypertensive patients, Effects of body position on resting lung volume in overweight and mildly to moderately obese subjects, Both body and arm position significantly influence blood pressure measurement, What is the accuracy of clinic blood pressure measurement, European Society of Hypertension -ESH- Working Group on Blood Pressure Monitoring, European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement, Validation of four automatic devices for self-measurement of blood pressure according to the International Protocol of the European Society of Hypertension, Validation of the Omron M7 (HEM-780-E) oscillometric blood pressure monitoring device according to the British Hypertension Society protocol, Multilevel and longitudinal modelling using Stata, Changes in blood pressure in the lying and sitting positions in normotensive, borderline and hypertensive subjects, The effect of different body positions on blood pressure, Epidemiological perspective of body position and arm level in blood pressure measurement, Influence of arm position on measurement of blood pressure, Influence of the arm position on intra-arterial blood pressure measurement, Factors associated with day-by-day variability of self-measured blood pressure at home: the Ohasama study, Blood volume distribution during head-up tilt induced central hypovolaemia in man, Effects of supine blood pressure on interpretation of standing up test in 500 patients with diabetes mellitus, Influence of different supine body positions on blood pressure: consequences for night blood pressure/dipper-status. Both models were set as repeated regression analyses, using patient's id as the cluster level, and fitted assuming an exchangeable correlation structure, with robust standard errors (based upon sandwich estimator).22 All recorded patient's variables (age, gender, BMI, heart rate, arm circumference, number of prescribed drugs/day) were included in the models a priori, regardless of their statistical significance. Importantly, besides those cases in which the use of Fowler's position to measure BP is forced by their clinical state (i.e., after thoracic surgery), Fowler's position might represent a valid alternative to supine or sitting positions also for other groups of patients, because its BP values were always intermediate between supine and sitting BP, and because the proportions of subjects showing a large BP variability between Fowler's and another position were always (and expectably) lower than those with large variations between supine and sitting positions. The main aim of the study was to detect a clinically relevant variation in SBP and DBP measurements in three different positions. When a standing person suddenly changes to the supine position, gravity no longer causes a shift in blood volume from the thoracic compartment to the legs and feet. The variability of mean BP by position was evaluated in six comparisons: supine vs. Fowler's; supine vs. sitting; Fowler's vs. sitting (for both SBP and DBP). Measured in supine, Fowler's, and sitting position, mean SBPs were 139.3 ± 14.0; 138.1 ± 13.8; 137.2 ± 13.7mmHg, respectively, and mean DBPs 80.1 ± 9.1; 81.9 ± 9.4; 83.0 ± 9.6mmHg, respectively. The mean age of the 250 hypertensive participants was 66.3 ± 13.4 years; males were 44.4%, obese 28.8% (mean BMI = 28.3 ± 4.0; mean arm circumference = 29.1 ± 2.7cm). d'Annunzio” Foundation, World Health Organization. . "When we get up out of a chair or bed, our body has to immediately work against gravity to make sure that the blood that would otherwise pool in the legs gets back up to the heart and head.". LIVESTRONG is a registered trademark of the LIVESTRONG Foundation. Statistical significance was defined as a two-sided P value <0.05 for all analyses, which were performed using STATA 10.1 (Stata, College Station, TX). As shown in Table 1, the absolute differences across positions were relatively small, the largest being the difference in DBP between supine and sitting positions (−2.8 ± 6.4mmHg). As a secondary analysis, we also computed the percentage of subjects with a “large difference” in BP in each of the six comparisons above defined. 6.Netea RT, Smits P, Lenders JW, Thien T. 9.Netea RT, Lenders JW, Smits P, Thien T. 10.Pierdomenico SD, Di Nicola M, Esposito AL, Di Mascio R, Ballone E, Lapenna D, Cuccurullo F. 13.Benedik PS, Baun MM, Keus L, Jimenez C, Morice R, Bidani A, Meininger JC. 2021 Indeed, besides statistical significance, if only the average difference from one position to another is considered, the clinical relevance of the BP variations according to body position may be of limited clinical importance, because the mean differences in both SBP and DBP across positions never exceeded 2.9mmHg. When individual rather than mean variations are considered, the influence of body position on SBP was clinically important in 15–30% of the subjects, who showed a difference in SBP ≥10mmHg from one position to another (while large differences in DBP were less frequently observed). 26.Webster J, Newnham D, Petrie JC, Lovell HG. A large difference was arbitrarily defined as a difference of >10mmHg between the mean BP measured in one position vs. another: as an example, in the comparison between the mean supine SBP and mean Fowler's SBP, a subject showed a large difference if his/her mean supine SBP value was 140mmHg and his/her mean Fowler's SBP value was <131mmHg or >149mmHg. The dizziness, lightheadedness, blurred vision, weakness, nausea or confusion that you may experience as a result is often just occasional, mild and short-lived, lasting for just a few minutes or so. 13; 15 July 2010). 14.Keir DL, Wise BA, Krebs C, Kelley-Arney C. 16.Netea RT, Lenders JW, Smits P, Thien T. 17.Sala C, Santin E, Rescaldani M, Cuspidi C, Magrini F. 19.Belghazi J, El Feghali R, Moussalem T, Rejdych M, Asmar R. 20.Coleman A, Steel S, Freeman P, de Greeff A, Shennan A. For some, it may also be a harbinger of heart disease. Absent that sort of sudden sharp course correction, he notes, you're liable to simply collapse. On one side, our multivariate analyses showed very little influence of random variability (as roughly measured by the change in BP according to the order of measurement) on the differences between supine, sitting, and Fowler's BP, which were strongly significant even after adjusting for measurement order and heart rate. 2. Potential interaction and higher power terms were evaluated for all covariates, and multicollinearity was explored in all models using Spearman's ρ: no collinearity was observed between BMI and arm circumference, therefore, both variables were kept into the final models. The independent association between the position of the measurement and BP has been evaluated using two separate generalized estimating equations models:21 the first with SBP as the dependent variable; the second with DBP. © 2011 by the American Journal of Hypertension, Ltd. BP was measured in all subjects nine times by the same person (EP) using the same, standard methodology: the patient was instructed by a specifically trained nurse to relax as much as possible, to keep quiet during the measurements, and to remove all clothing that covered the location of cuff placement on the left arm. However, although the mean difference in SBP from supine to sitting position (3.1 ± 8.5mmHg) was higher in obese subjects, such difference remained significant in nonobese subjects (1.7 ± 9.2mmHg), the rates of subjects with large variations were similar in nonobese individuals (data not shown), and obesity was not associated with BP in multivariate analyses. 31.van Dijk JG, Tjon-A-Tsien AM, Kamzoul BA, Kramer CG, Lemkes HH. Fowler's position may represent a valid alternative to sitting and supine positions for BP measurement in clinical practice. It's called autoregulation, and it works, Dr. Osborne says, by enlisting your autonomic nervous system (ANS) to kick into high gear whenever you rise from a seated or lying down position. this subject of positional changes in blood pressure and relate that to the risk of developing hypertension in the future. 1. This is because there is no conclusive evidence that the benefits outweigh the risks of treating with medicines to blood pressure lower than 140/90 mm Hg. Following 20 min of supine rest, the active transition to standing was accompanied by an immediate increase in systolic pressure of 29f6 mmHg (mean * SEM). Heart rate (bpm) Standing Sitting Supine Males 79±5 71±5 60±4* Females 91±6** 72±4# 58±3| Effects of body position and arm on blood pressure 3 Table 1. Systolic BP (SBP) and diastolic BP (DBP) were recorded using an automatic oscillometric device. Between July and November 2010, all subjects admitted to our clinic were asked to participate. Maxwell R. Berry, Bayard T. Horton, Alexander R. Maclean, The Importance of Studying the Postural Responses of the Blood Pressure and the Heart Rate, with a Note on the Method of Taking the Blood Pressure in the Erect Posture, Medical Clinics of North America, 10.1016/S0025-7125(16)36688-3, 24, 4, (1095-1126), (1940). Standing has a positive effect on spasticity. When standing up threatens to destabilize your blood pressure, the autonomic nervous system quickly battles gravity and saves the day. Between two consecutive measurements, the patient was asked to relax for 5 minutes. Blood pressure lying down (supine position) vs. standing. The study protocol was approved by the local ethics committee (Record no. The instrument was clinically validated by the British Hypertension Society.19,20 For 12h before the measurements, patients were required not to smoke, to play sports, to eat chocolate or to drink beverages containing caffeine or other psychoactive substances (i.e., alcohol or Taurine). In routine clinical practice we get older, Kamzoul BA, Kramer CG, Lemkes.... Long shall the patient was asked to relax for 5 minutes 2010 all! He says measure at the time of blood pressure supine vs standing as comparable to sitting and supine positions for BP measurement in practice. 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