Understanding measurement of postural hypotension: a nationwide survey of primary care practice in England

Conference: 
SAPC ASM 2023 - Brighton
Talk Code: 
5B.2
Presenter: 
Sinéad TJ McDonagh
Twitter: 
@Sinead1989
Co-authors: 
Sinéad TJ McDonagh, Rosina Cross, Jane Masoli, Judit Konya, Gary Abel, James Sheppard, Bethany Jakubowski, Cini Bhanu, Jayne Fordham, Katrina Turner, Sallie Lamb, Rupert Payne, Richard McManus, John L Campbell, Christopher E Clark
Author institutions: 
University of Exeter, University of Oxford, King's College London, University College London, Mid Devon Medical Practice, University of Bristol

Problem

Postural hypotension is the sustained reduction of systolic blood pressure of at least 20mmHg or diastolic blood pressure of 10mmHg within three minutes of standing. It is associated with falls, all-cause mortality and cognitive decline. Postural hypotension diagnostic criteria require lying-to-standing blood pressure measurements and testing is recommended in older adults or individuals with symptoms or diabetes. Postural hypotension is common, with prevalence estimated at 19% in older primary care patients. However, it is infrequently (<1%) recorded in routine English primary care practice data, suggesting postural hypotension testing and/or recording is under-utilised in this setting; the reasons for such limited postural hypotension testing and/or recording have not yet been explored in detail.

The aim of this study was to understand current postural hypotension measurement and management strategies in primary care practices across England.

 

Approach

Clinical Research Networks circulated an online survey to primary care staff involved in measurement of blood pressure from 10th August until 8th December 2022. Demographics and responses were summarised as percentages and/or median (inter-quartile ranges (IQR)) and chi2 tests. Mixed effect logistic regression models are underway to examine response variation according to professional characteristics and practice demographics. Final analyses will be presented at the conference.

Findings

Replies from 703 practitioners in 242 practices were received; predominantly from doctors (51%), nurses (28%) and healthcare assistants (HCAs; 11%), plus pharmacists, paramedics and other roles; median age 45 (IQR 38 to 53) years, 72% female. Overall, doctors (97%) and nurses (92%) reported checking for postural hypotension more often than HCAs (82%) or pharmacists (80%; p<0.001). They all usually check when symptoms are present (97%). Other reasons for checking - patients aged over 80 years (24%); hypertension reviews (17%); medication reviews (12%) or diabetes reviews (11%) – were all more commonly undertaken by allied health professionals than by doctors (p<0.001). Standing blood pressure measurements are regarded as feasible, usually (77%) following sitting; only 22% use lying-to-standing measurements. 64% observe a rest period (median 5 (2 to 5) minutes) before sitting or lying measurements and 1 (IQR 1 to 2) standing blood pressure measurements are made, usually (66%) within the first minute of standing.

Consequences

Findings suggest that most postural hypotension assessments in primary care do not meet current guideline criteria. The results from this survey are expected to inform and influence future national guidelines to support detection of postural hypotension.

Submitted by: 
Sinead McDonagh
Funding acknowledgement: 
National Institute for Health and Care Research (NIHR) School for Primary Care Research (SPCR) - project no. 580. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health.