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

Background Postural hypotension (PH) is associated with excess mortality, falls and cognitive decline. PH is poorly recorded in routine general practice (practice) records. Few practice studies have explored measurement and diagnosis of PH. Aim To understand how PH is measured, diagnosed and managed in practice. Design and setting Online survey of practice staff in England. Method Clinical Research Networks distributed the survey to practices, seeking individual responses from any clinical staff involved in routine blood pressure (BP) measurement. Responses were analysed according to role and demographic data using descriptive statistics. Multivariable modelling of undertaking postural BP measurements was performed. Results 703 responses were received from 243 practices (mean practice-level response rate 17%). Half (362; 51%) of respondents were doctors, 196 (28%) practice nurses and 77 (11%) healthcare assistants (HCAs). Eight percent did not routinely check for PH, usually citing time constraints. For the remaining 92%, postural symptoms were the predominant reason for checking (97% respondents); only 24% cited any other guideline indication for PH testing. 77% used sit-to-stand BP measurements; only 25% measured standing BP for more than one minute. On regression modelling, other professionals tested less for PH than doctors (Odds ratios: nurses 0.323 (95% confidence interval 0.117 to 0.894), HCAs 0.102 (0.032 to 0.325), pharmacists 0.986 (0.024 to 0.412)). Conclusion Awareness of reasons, besides symptoms, and adherence to guidelines for PH testing, are low. Time is the key barrier to improved testing for PH. Clarity on pragmatic methods of measuring PH in practice would also facilitate measurement uptake.