d'Annunzio” Foundation, World Health Organization. At multivariate analysis, mean SBP significantly decreased if measured in Fowler's and sitting positions, as compared to supine. Blood pressure can be categorized as sitting, supine, or orthostatic according to the position of measurement. 2. The differences in either SBP and DBP according to the position have been initially investigated using Wilcoxon-matched-pairs signed-ranks test, separately for each comparison. Finally, the number of subjects with at least one “random” large BP difference in each position was summed to obtain the proportion of subjects with at least one large difference in BP in at least one position. 2. 2.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JLJr, Jones DW, Materson BJ, Oparil S, Wright JTJr, Roccella EJ. The authors declared no conflict of interest. Second, it has been documented that comorbidities such as autonomic dysfunction in the aged, diabetic neuropathy, and parkinsonism, and antihypertensive agents such as β-blockaders and diuretics may enhance the difference of BP by body position and may thus confound the results of the study.31 However, we repeated all univariate (and multivariate) analyses stratifying (adjusting) for use of diuretics and β-blockers, with no relevant variation in the results (data not shown). Copyright © 2021 American Journal of Hypertension, Ltd. Following 20 min of supine rest, the active transition to standing was accompanied by an immediate increase in systolic pressure of 29f6 mmHg (mean * SEM). Accordingly, it may be indicated to measure the BP in the same position throughout the overall duration of the therapy. 14.Keir DL, Wise BA, Krebs C, Kelley-Arney C. 16.Netea RT, Lenders JW, Smits P, Thien T. 17.Sala C, Santin E, Rescaldani M, Cuspidi C, Magrini F. 19.Belghazi J, El Feghali R, Moussalem T, Rejdych M, Asmar R. 20.Coleman A, Steel S, Freeman P, de Greeff A, Shennan A. Department of Medicine and Science of Aging, University “G. For 6h before test (or during the night if the test was in the morning), participants were requested not to drink more than two “normal” glasses of water. "If it's very severe or a repeating issue, there may be something going on that needs to be checked out," Dr. Osborne says. Use of this web site constitutes acceptance of the LIVESTRONG.COM Several studies compared BP values when measured in sitting or supine positions, reporting variations which ranged from 0 to a maximum of 10mmHg.5,7,9,23,–25 In most studies, the average SBP was higher when measured in supine than sitting position,9,17,24,26 whereas the mean DBP was usually highest in sitting position.7,8,23,27 Our sample of hypertensive subjects showed the same trends for SBP and DBP, although the differences in SBP9,17,26 and DBP7,23,27 across positions were generally smaller that in most previous studies.7,8,9,17,23,24,26,27. In the new blood pressure guidelines, they stated systolic blood pressure has been reported to be 3-10 mmHg higher in the supine (lying) than the seated position. 31.van Dijk JG, Tjon-A-Tsien AM, Kamzoul BA, Kramer CG, Lemkes HH. However, the study has some limitations that must be considered: first, it is monocentric, the sample is relatively small, and the amount of “large variation in BP” has been arbitrarily set at 10mmHg, but results may vary if other thresholds are considered. National Heart, Lung, and Blood Institute, Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Guidelines for management of hypertension: report of the third working party of the British Hypertension Society, Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research, The measurement of blood pressure: sitting or supine, once or twice, Does it matter whether blood pressure measurements are taken with subjects sitting or supine, Office blood pressures in supine, sitting, and standing positions: correlation with ambulatory blood pressures, Effect of Fowler's body position on blood pressure measurement, Influence of body and arm position on blood pressure readings: an overview, Prognostic value of different indices of blood pressure variability in hypertensive patients, Effects of body position on resting lung volume in overweight and mildly to moderately obese subjects, Both body and arm position significantly influence blood pressure measurement, What is the accuracy of clinic blood pressure measurement, European Society of Hypertension -ESH- Working Group on Blood Pressure Monitoring, European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement, Validation of four automatic devices for self-measurement of blood pressure according to the International Protocol of the European Society of Hypertension, Validation of the Omron M7 (HEM-780-E) oscillometric blood pressure monitoring device according to the British Hypertension Society protocol, Multilevel and longitudinal modelling using Stata, Changes in blood pressure in the lying and sitting positions in normotensive, borderline and hypertensive subjects, The effect of different body positions on blood pressure, Epidemiological perspective of body position and arm level in blood pressure measurement, Influence of arm position on measurement of blood pressure, Influence of the arm position on intra-arterial blood pressure measurement, Factors associated with day-by-day variability of self-measured blood pressure at home: the Ohasama study, Blood volume distribution during head-up tilt induced central hypovolaemia in man, Effects of supine blood pressure on interpretation of standing up test in 500 patients with diabetes mellitus, Influence of different supine body positions on blood pressure: consequences for night blood pressure/dipper-status. As a secondary analysis, we also computed the percentage of subjects with a “large difference” in BP in each of the six comparisons above defined. Most guidelines for management of hypertension do not give special preference to a specific position of patient during blood pressure (BP) measurement, suggesting that BP readings taken with patients sitting, supine and standing are equivalent. Supine position or lying down: After one minute of the standing position, blood pressure was measured in the lying down position. Clinical practice and related research often use sitting blood pressure to diagnose hypertension, whereas less attention has … BP random variability was found to be large regardless of body position, reinforcing the need for operators to closely follow current guidelines that recommend ≥2 recordings at each measurement. By contrast, DBP increased of 1.8 and 2.9mmHg, respectively (both P < 0.001). , Copyright © OH increases the risk of … Take the blood pressure and pulse, recording the numbers and identifying them as “lying down.” 3. Standing has been shown to delay the appearance of contractures and improve those that already exist.2,3For individuals who lack the strength to stand, the standing frame keeps them in a good position to stretch their lower extremity and trunk muscles for extended periods. Leaf Group Ltd. When individual rather than mean variations are considered, the influence of body position on SBP was clinically important in 15–30% of the subjects, who showed a difference in SBP ≥10mmHg from one position to another (while large differences in DBP were less frequently observed). In fact, everyone will likely experience this kind of dizziness, at least to a mild degree, as they age, which is why we always tell our more mature patients to be careful not to get up out of a chair or bed too quickly. Standing has a positive effect on spasticity. First, the mean supine, Fowler's, and sitting SBP and DBP have been computed for each patient. Participants and study design. Notable differences have been observed between sitting and supine blood pressures, 1 and human bodies spend one-third of the time in the supine position. BP was measured in all subjects nine times by the same person (EP) using the same, standard methodology: the patient was instructed by a specifically trained nurse to relax as much as possible, to keep quiet during the measurements, and to remove all clothing that covered the location of cuff placement on the left arm. This is the position in which the person’s heart is not under any kind of stress and the heartbeat is normal. Measuring blood pressure while standing is not advisable, as the correct blood pressure is only recorded when a patient is in a supine position. This is of particular relevance because BP differences may impact much more on hypertensive than normotensive subjects, as the clinical management of hypertension is largely based upon BP measurements. Effect of Age on the Hemodynamic Response to Posture in Nonelderly Hypertensive Patients, Effect of Back Support and Stethoscope Head on Seated Blood Pressure Determinations, Self-Reported Sitting Time Is Associated With Higher Pressure From Wave Reflections Independent of Physical Activity Levels in Healthy Young Adults. No differences in BP were observed according to heart rate. 30.Matzen S, Perko G, Groth S, Friedman DB, Secher NH. The material appearing on LIVESTRONG.COM is for educational use only. Effects of body position on blood pressure Blood pressure is commonly measured in the seated or supine position; however, the two positions give different measurement values. Upon standing, a complex mechanism of responses by the autonomic nervous system, works to ensure that adequate blood volume continues to circulate the human body, preventing almost a liter of blood from pooling in the extremities and abdomen. LIVESTRONG is a registered trademark of the LIVESTRONG Foundation. There is only one recent study that compared BP values as measured in Fowler's position with those measured in sitting and/or supine positions.8 This study was based upon normotensive subjects, and found that Fowler's BP significantly differed from sitting and supine BP, showing values that are always intermediate between those obtained using the two most common positions.8 The present results, based upon subjects in active antihypertensive treatment (which might have reduced BP variability), are in complete agreement. Between July and November 2010, all subjects admitted to our clinic were asked to participate. We performed a cross-sectional study to compare BP values obtained in supine, sitting, and Fowler's positions in essential hypertensive subjects. Heart rate (bpm) Standing Sitting Supine Males 79±5 71±5 60±4* Females 91±6** 72±4# 58±3| Effects of body position and arm on blood pressure 3 Table 1. Global Strategy on Diet, Physical Activity and Health, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2021 In addition to BP, the following variables were measured by the nurse: height (bare foot) and weight (underwear), heart rate (which is automatically measured by the oscillometric device during each BP measurement), and arm circumference (naked arm). Therefore, the bias caused by the inclusion of obese individuals did not seem to relevantly alter the results of the study. Measuring lying and standing blood pressure (BP) is an important clinical observation in older hospital inpatients. Ask the resident to lie down on the bed for five minutes to allow his/her blood pressure to settle to a normal supine pressure. The instrument was clinically validated by the British Hypertension Society.19,20 For 12h before the measurements, patients were required not to smoke, to play sports, to eat chocolate or to drink beverages containing caffeine or other psychoactive substances (i.e., alcohol or Taurine). and Gravity is your friend. Given that two measurements are not always taken in routine clinical practice, operators should be informed of the importance of this procedure and more emphasis on the topic should be given in their educational pathway. Exercise intervention to Normalize blood pressure and nocturnal Dipping in HyperTensive patients (END-HT): protocol of a randomized controlled trial, Risk of Incident Hypertension According to Physical Activity and Temporal Changes in Weight, Salt intake, aldosterone secretion and obesity: role in the pathogenesis of resistant hypertension, Renal sodium handling: perspective on adaptation to clinical practice, Associations between Social Determinants and Hypertension, Stage 2 Hypertension and Controlled Blood Pressure among Men and Women in the US, http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf, http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm, Receive exclusive offers and updates from Oxford Academic. Our nervous system is not as sharp as it once was. Alan Mozes is an NYC-based medical reporter and photographer. The picture is further complicated by the frequent use in routine clinical practice of positions that are intermediate between supine and sitting, such as Fowler's position, in which the patients rest in their bed in a partial sitting position.1073.11,12 Fowler's position is commonly used to facilitate breathing and eventually reduce abdominal pain in immobilized subjects and/or patients with respiratory diseases or after surgery, but it may also be used in other patients just to relax abdominal muscles.11,13,–15. This is because a drop in BP on standing, known as orthostatic hypotension (OH) is common in older people and in acute illness and, therefore, in hospital patients. Such a fall in BP with standing is called postural hypotension (low blood pressure), which, when significant, can cause weakness, lightheadedness, and even fainting. How to measure lying and standing blood pressure and why it is important for our patients. 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