Sinead McDonagh

Award title: SPCR Postdoctoral Fellowship  

Project Title: Thresholds used for diagnosing postural hypotension 

Brief Summary:     

Postural hypotension, the change in blood pressure when rising from lying or sitting to standing, is typically diagnosed according to the consensus definition: ‘a sustained reduction of systolic blood pressure of at least 20mmHg or diastolic blood pressure of 10mmHg within 3 min of standing or head-up tilt to at least 60° on a tilt table’. It is common and can result in memory problems, falls or death. 

Doctors and nurses tend not to check for postural hypotension unless symptoms are reported. If postural hypotension is checked for, the sit-to-stand method is often used, rather than lying-to-stand. However, limited evidence exists to support this method, and the diagnostic threshold is generally not adjusted to account for typically smaller blood pressure changes when moving from sitting-to-standing versus lying-to-standing. 

The aim of this fellowship is to undertake, and seek funding for, a programme of work to determine the thresholds used to diagnose postural hypotension using the sit-to-stand method and further understand current UK primary care practice for this condition.   

In a pilot study, we will recruit participants diagnosed with postural hypotension from GP surgeries, falls clinics and existing research studies to check if the proposed assessments are acceptable. Volunteers will have blood pressure measured, by wearing a cuff on the arm and a fingertip sensor, when moving from lying-to-standing and sitting-to-standing. A symptom questionnaire, memory assessment, grip strength test and a short walking test will also be undertaken.  

We will seek funding from the NIHR Research for Patient Benefit programme to undertake this study on a larger scale. We will also explore existing datasets to help determine how many people have postural hypotension and how this changes when different thresholds are used to diagnose it. We will develop a School for Primary Care Research grant application to further understand postural hypotension measurement methods in UK primary care.   

We will engage with patient and public involvement advisors throughout the programme to ensure the work undertaken is sensitive to the needs of people with postural hypotension. We will disseminate findings in research journals, at national and international conferences and to key stakeholders and patients. 

Start date:  September 2021 

End date:  August 2023