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‘Transient immediate orthostatic hypotension’ is preferable to ‘initial’ orthostatic hypotension

Benditt, David G. ; Fedorowski, Artur LU orcid ; Sutton, Richard LU ; van Dijk, J. Gert ; Baron-Esquivas, G. ; Biaggioni, I. ; Brignole, M. ; De Jong, J. S.Y. ; De Lange, F. J. and Freeman, R. , et al. (2025) In Autonomic Neuroscience: Basic and Clinical 260.
Abstract

A drop of systemic blood pressure (BP) occurring shortly after individuals move from supine or seated position to upright posture with subsequent prompt spontaneous resolution is a common physiological occurrence in humans. If the induced hypotension is severe, lightheadedness or postural instability leading to falls and injury may occur. By consensus, a transient systolic BP drop >40 mmHg within 15 s of standing is deemed abnormal and has become termed ‘initial orthostatic hypotension’ (initial OH, iOH). However, the term ‘initial OH’ implies that another hypotensive event will follow shortly. In essence, if an OH event is deemed to be ‘initial’, then one might reasonably assume that a subsequent OH event is imminent. However, in... (More)

A drop of systemic blood pressure (BP) occurring shortly after individuals move from supine or seated position to upright posture with subsequent prompt spontaneous resolution is a common physiological occurrence in humans. If the induced hypotension is severe, lightheadedness or postural instability leading to falls and injury may occur. By consensus, a transient systolic BP drop >40 mmHg within 15 s of standing is deemed abnormal and has become termed ‘initial orthostatic hypotension’ (initial OH, iOH). However, the term ‘initial OH’ implies that another hypotensive event will follow shortly. In essence, if an OH event is deemed to be ‘initial’, then one might reasonably assume that a subsequent OH event is imminent. However, in the setting of abrupt movement to upright posture, the BP drop is usually solitary and brief (resolution within 15–30 s); thereafter the individual is usually OH symptom-free until they undertake another similar postural change. Currently, there is no single descriptor for a posture change driven, short-lived, spontaneously resolving OH event, without the implication that further hypotension is imminent as is implied by the term ‘initial OH’. In order to foster more accurate nomenclature, we recommend that ‘initial OH’ be retired, and ‘immediate OH’ or transient ‘immediate OH’ be substituted. While ‘immediate’ OH may be imperfect, it conveys an early onset event without implying additional imminent OH. Thus immediate OH or transient immediate are more accurate descriptors of this common transient hypotensive event. The abbreviation, ‘iOH’, remains unchanged.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, Immediate, Initial, Orthostatic hypotension
in
Autonomic Neuroscience: Basic and Clinical
volume
260
article number
103288
publisher
Elsevier
external identifiers
  • scopus:105005957009
  • pmid:40424818
ISSN
1566-0702
DOI
10.1016/j.autneu.2025.103288
language
English
LU publication?
no
additional info
Publisher Copyright: © 2025 Elsevier B.V.
id
5fb63657-ed14-471d-ad62-c663128f4dae
date added to LUP
2025-06-02 15:16:09
date last changed
2025-06-30 18:21:40
@article{5fb63657-ed14-471d-ad62-c663128f4dae,
  abstract     = {{<p>A drop of systemic blood pressure (BP) occurring shortly after individuals move from supine or seated position to upright posture with subsequent prompt spontaneous resolution is a common physiological occurrence in humans. If the induced hypotension is severe, lightheadedness or postural instability leading to falls and injury may occur. By consensus, a transient systolic BP drop &gt;40 mmHg within 15 s of standing is deemed abnormal and has become termed ‘initial orthostatic hypotension’ (initial OH, iOH). However, the term ‘initial OH’ implies that another hypotensive event will follow shortly. In essence, if an OH event is deemed to be ‘initial’, then one might reasonably assume that a subsequent OH event is imminent. However, in the setting of abrupt movement to upright posture, the BP drop is usually solitary and brief (resolution within 15–30 s); thereafter the individual is usually OH symptom-free until they undertake another similar postural change. Currently, there is no single descriptor for a posture change driven, short-lived, spontaneously resolving OH event, without the implication that further hypotension is imminent as is implied by the term ‘initial OH’. In order to foster more accurate nomenclature, we recommend that ‘initial OH’ be retired, and ‘immediate OH’ or transient ‘immediate OH’ be substituted. While ‘immediate’ OH may be imperfect, it conveys an early onset event without implying additional imminent OH. Thus immediate OH or transient immediate are more accurate descriptors of this common transient hypotensive event. The abbreviation, ‘iOH’, remains unchanged.</p>}},
  author       = {{Benditt, David G. and Fedorowski, Artur and Sutton, Richard and van Dijk, J. Gert and Baron-Esquivas, G. and Biaggioni, I. and Brignole, M. and De Jong, J. S.Y. and De Lange, F. J. and Freeman, R. and Furlan, R. and Grubb, B. and Hamdan, M. H. and Kenny, R. A. and Lim, P. B. and Angel, Moya Mitjans and Olshansky, B. and Rafanelli, M. and Raj, S. R. and Reyes, J. and Rivasi, G. and Russo, V. and Sheldon, R. and Stewart, J. M. and Thijs, R. and Ungar, A. and Van Rossum, I. A.}},
  issn         = {{1566-0702}},
  keywords     = {{Blood pressure; Immediate; Initial; Orthostatic hypotension}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Autonomic Neuroscience: Basic and Clinical}},
  title        = {{‘Transient immediate orthostatic hypotension’ is preferable to ‘initial’ orthostatic hypotension}},
  url          = {{http://dx.doi.org/10.1016/j.autneu.2025.103288}},
  doi          = {{10.1016/j.autneu.2025.103288}},
  volume       = {{260}},
  year         = {{2025}},
}