How do you establish the diagnosis

Diagnosis is based on the patient's history and discovery of blood pressure fall with position change, as mentioned above. The evaluation is performed as follows: the patient is supine for about 15 minutes when the blood pressure is measured. Subsequently, the patient is asked to stand up and stay standing for five minutes. Blood pressure is measured every minute for a total of five minutes and the difference of the lower blood pressure value in the standing position compared to that in the supine is recorded. Variations of blood pressure during this procedure have low reproducibility and can vary from day to day or even at different times of the same day. Thus, the diagnosis can be missed in a patient who is suffering from orthostatic hypotension. For this reason, when clinical suspicion is high but the initial test negative, repeating the procedure on another day is suggested.

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