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Clinical exam · General exam and vital signs

Orthostatic vital signs !

  • Vital sign

Blood pressure and pulse lying down and then standing, to see whether the body copes with the change of position.

Updated 2026-11-01

See it in 3D: Carotid bifurcation

What it is

Orthostatic vital signs compare blood pressure and heart rate lying down with those taken after standing up. On standing, blood pools in the legs and the baroreceptors must raise heart rate and vascular tone. If that response fails or volume is short, pressure falls: orthostatic hypotension, a common cause of dizziness, syncope and falls in older adults.

Reference values

  • Positive: systolic fall above 20 mmHg or diastolic fall above 10 mmHg within the first three minutes of standing.
  • Normal response: pressure changes little and the pulse rises slightly.

Structure

  • Baroreceptors in the carotid sinus and aortic arch sense the fall in pressure on standing.
  • The autonomic pathway responds by raising heart rate and causing peripheral vasoconstriction.

How to measure it

  1. Explain the test and check the patient can stand with help; keep the bed or a chair at hand.
  2. Keep the patient lying down for five minutes and measure blood pressure and pulse.
  3. Help them stand, supporting them, with the arm supported at heart level.
  4. Measure blood pressure and pulse at one minute and at three minutes of standing.
  5. Ask about dizziness, blurred vision or feeling faint at each reading.
  6. If the patient cannot stand, measure sitting up and record that.
  7. Record the values for each position with timing and symptoms, and stop if fainting seems imminent.

What abnormal values mean

  • Hypovolemia: vomiting, diarrhea, bleeding, diuretics or poor intake; usually with compensatory tachycardia.
  • Autonomic dysfunction: diabetic neuropathy, Parkinson disease, multiple system atrophy; little or no pulse rise.
  • Medicines: vasodilators, alpha-blockers, antipsychotics and diuretics.
  • Prolonged bed rest and the changes of normal aging.
  • Postprandial hypotension, made worse by alcohol.
  • A negative test does not rule out syncope from another cause (arrhythmia, valve disease).

Common errors

  • Measuring the moment the patient stands instead of waiting for one and three minutes.
  • Not letting the patient lie long enough before the first reading.
  • Leaving the patient alone on standing: risk of a fall.
  • Forgetting to record the pulse, which separates hypovolemia from autonomic failure.

Test yourself

Think of the answer, then tap the question to see it.

What criteria define orthostatic hypotension?

A fall of more than 20 mmHg systolic, more than 10 mmHg diastolic or both, within three minutes of standing.

What does a fall in pressure on standing without a rise in pulse suggest?

Autonomic failure, for example from diabetic neuropathy, Parkinson disease or drugs, because the baroreflex cannot raise the heart rate.

When is blood pressure measured after standing up?

At one minute and at three minutes of standing, after five minutes lying down.

What safety measure is essential in this test?

A clinician stays beside the patient on standing to support them and return them to bed if dizzy.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Orthostatic Hypotension - Cardiology - MSD Manual Professional Edition (Merck & Co. (MSD Manual Professional Edition), 2025); Dehydration: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine (MedlinePlus), 2025).

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Representative model, for educational purposes only.