Postural blood pressure assessment
A simple test that measures blood pressure lying or sitting and then standing, to check whether it drops too much on standing — a common and often treatable cause of dizziness and falls in older people.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- The test measures blood pressure lying or sitting and then standing, to check for an abnormal drop on standing.
- A drop in the top number of 20 or more, or the bottom number of 10 or more, within three minutes of standing is the usual definition.
- It can find a common, treatable cause of dizziness and falls, but it does not by itself explain the cause.
- Results can vary from day to day and with medicines, fluids and time of day, so it is sometimes repeated.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Finds a common and often treatable cause of dizziness, unsteadiness and falls
It is the wrong first test for someone with sudden chest pain, stroke symptoms or collapse with injury, who needs emergency assessment.
You rest, then stand while readings are taken. Tell the clinician at once if you feel dizzy or faint so they can help you sit or lie down.
A clear explanation of the result and what it means for falls risk and treatment.
You rest, then stand while readings are taken. Tell the clinician at once if you feel dizzy or faint so they can...
Any brief dizziness settles quickly once you are seated. You can usually go about your day as normal.
The clinician explains the result and whether your blood pressure dropped abnormally on standing.
If a cause is found — often a medicine — changes may be made and their effect reviewed, sometimes with a repeat...
What is a postural blood pressure assessment?
A postural blood pressure assessment measures your blood pressure first while you are lying down or sitting, and then again after you stand up. It checks whether your blood pressure falls too much when you change position — a condition called orthostatic, or postural, hypotension.
Normally the body adjusts quickly when you stand, keeping enough blood reaching the brain. If that adjustment is sluggish, blood pressure can dip, causing light-headedness, dizziness, unsteadiness or even fainting — and it is a common and often treatable cause of falls in older people.
The test is quick, usually not painful and uses an ordinary blood pressure cuff. The key is timing: readings are taken lying or sitting, then again at about one minute and three minutes after standing.
It tells you whether your blood pressure drops abnormally, and how much. It does not, on its own, explain why — that depends on things like medicines, hydration, other conditions and how your nervous system is working, which your clinician will look into.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Bedside test versus tilt-table test
| Bedside lying/standing | Tilt-table test |
|---|---|
| Quick, at the bedside or at home | Specialised hospital test |
| Uses an ordinary cuff | Uses a motorised tilting table |
| Good first test for most people | For unclear results or unexplained fainting |
| Takes about 10–15 minutes | Takes longer and needs monitoring |
Most people only need the simple bedside test. A tilt-table test is reserved for selected cases.
Preparing for your test
- Bring a full list of your medicines, including blood pressure tablets, water tablets (diuretics), and anything for the prostate, Parkinson's or depression, as several can affect the result.
- Mention if you have felt dizzy, light-headed or unsteady on standing, or have had any falls or blackouts.
- Try to be normally hydrated — being very dehydrated can affect the reading — unless told otherwise.
- Wear clothing that lets a cuff fit easily on your upper arm.
- Tell the clinician about recent illness, vomiting, diarrhoea or poor fluid intake, which can lower blood pressure.
- Note the time of day your symptoms are worst — readings can differ, for example just after meals or first thing.
- Allow a little extra time, as you need to rest before the first reading.
What happens
You first rest lying flat (or sitting, if you cannot lie down) for at least five minutes, so your blood pressure can settle. The clinician measures it with a cuff on your upper arm.
You then stand up, with help if you need it. Your blood pressure is measured again soon after standing, usually around one minute, and again at about three minutes. The clinician watches how the numbers change and asks whether you feel dizzy or light-headed at any point.
The whole thing takes about ten to fifteen minutes and is usually not painful. If you feel faint when you stand, tell the clinician straight away — they will help you sit or lie back down.
Afterwards they explain what the numbers show. If your blood pressure drops abnormally, they will look at possible causes, especially your medicines, and discuss what to do next.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- It is the wrong first test for someone with sudden chest pain, stroke symptoms or collapse with injury, who needs emergency assessment.
- If a person genuinely cannot stand or be safely helped to stand, the standard test cannot be done and an alternative is needed.
- It does not investigate fainting due to heart rhythm problems on its own; an ECG or rhythm monitoring may be needed.
- A normal result should not be used to dismiss ongoing symptoms, because the problem can vary through the day.
Delay or rearrange if…
- The person is acutely unwell, dehydrated or has an untreated infection that may temporarily affect blood pressure.
- They feel too unwell or unsteady to stand safely on the day.
- Recent medicine changes mean a repeat in a few weeks would be more informative.
- Symptoms are clearly worst at a particular time, so testing then would be more useful.
Alternatives to discuss
- A sitting-to-standing test if the person cannot lie flat.
- Home or repeated readings at the time symptoms occur.
- A tilt-table test for unclear results or unexplained fainting.
- An ECG or heart rhythm monitor if a cardiac cause is suspected.
- A medication review and hydration check as first steps where a cause is likely.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Finds a common and often treatable cause of dizziness, unsteadiness and falls
- Quick, usually not painful and needs no special preparation in most cases
- Can guide safe changes to medicines that may be causing the drop
- Helps explain symptoms that might otherwise be put down to age
- Can be repeated easily, including at home, to track the effect of changes
Risks & complications
- Brief light-headedness or dizziness when you stand for the test
- A reading that varies from day to day, so it may need repeating
- Mild discomfort from the cuff tightening on your arm
- Feeling faint enough to need to sit or lie down quickly
- A normal result on the day even though you have symptoms at other times (a false reassurance)
- Needing further tests if the cause is unclear
- Actually fainting during the test, which the clinician is prepared for
- A fall while standing if support is not on hand — so help should always be available
The main limitation is that the result is a snapshot. Blood pressure on standing changes with the time of day, meals, fluids, illness and medicines, so a single normal test does not always rule out the problem, and a single abnormal one may not be the whole story. The most useful next step is usually a careful look at your medicines. Ask what the result means for your treatment, and whether the test should be repeated at the time your symptoms are worst.
Published figures to discuss
The test itself is very low risk; the main caution is brief dizziness or, rarely, fainting on standing, which is why support should be at hand. The figures below describe how common orthostatic hypotension is and the agreed thresholds for an abnormal result, drawn from published clinical sources, rather than risks of the test.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Abnormal blood pressure drop (definition) | Systolic fall of at least 20 mmHg or diastolic fall of at least 10 mmHg within 3 minutes of standing (at least 30 mmHg systolic if the person has high blood pressure) | This is the widely used consensus definition; symptoms with a smaller drop, or a fall to below 100 mmHg on standing, may also be significant. | Guide sourcesClinical context |
| How common it is in older people | Reported in roughly 1 in 5 adults aged 60 and over, and over 1 in 4 of those aged 85 and over | Prevalence rises with age and with the number of relevant medicines; figures vary between studies and settings. | Orthostatic hypotension — StatPearls (NCBI)ncbi.nlm.nih.govPublished figure |
| Faint or near-faint during the test | Uncommon; not reliably quantified | The clinician is prepared to help the person sit or lie down quickly, which is why support should always be available. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no recovery needed after this test. You can carry on as normal straight away. "Afterwards" is mainly about understanding the result and any changes to your medicines.
- Brief light-headedness on standing that quickly passes
- Being asked to repeat the test on another day or at a different time
- Adjusting to changed medicines if a cause is found
- No change at all if the result is normal and no action is needed
Aftercare
- Follow any advice about changing the timing or dose of medicines, and never stop a medicine without being told to.
- Stand up slowly, especially after lying or sitting for a while, and pause before walking off.
- Keep well hydrated unless your clinician has advised limiting fluids for another reason.
- Note when dizziness happens — time of day, after meals, after medicines — to help guide treatment.
- Report any falls, blackouts or worsening dizziness promptly.
- Keep follow-up appointments so the effect of any changes can be checked.
- Make your home safer if falls are a concern — good lighting, no loose rugs, support where needed.
- Full list of medicines, including water tablets
- A note of when dizziness or unsteadiness is worst
- Details of any falls or blackouts
- Clothing that allows a cuff on the upper arm
- Normal fluid intake unless told otherwise
- A little extra time for the rest period
- Someone with you if you feel unsteady standing
⚠ Get urgent help if…
- Fainting or blacking out, especially with injury
- A fall causing a head injury, severe pain or inability to get up
- Chest pain, palpitations or severe breathlessness with the dizziness
- Sudden, severe or one-sided headache, or stroke symptoms — face drooping, arm weakness, slurred speech (call 999)
- Dizziness with signs of dehydration or being unable to keep fluids down
- Worsening dizziness after a medicine change — contact your clinician
- Repeated near-faints that stop you standing or walking safely
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A clear result tells you whether your blood pressure drops abnormally on standing and roughly how much. Combined with your symptoms, it helps explain dizziness or falls and points to what might help — often adjusting medicines, improving hydration, or simple measures like standing up slowly.
The test cannot, by itself, tell you the underlying cause, and a normal result on one day does not always rule out the problem, because it can vary. A good assessment looks at the numbers, your symptoms and your medicines together, rather than relying on a single reading.
A result reflects your blood pressure control at the time of testing. Because it changes with medicines, fluids, illness and time of day, the test is often repeated — for example after a medicine change, or at the time your symptoms are worst. Ongoing symptoms or new falls are good reasons to test again.
Related tests, treatments or support
A postural blood pressure check is often part of a wider falls assessment or comprehensive geriatric assessment. It is commonly combined with a medication review, a heart rhythm check such as an ECG, blood tests for causes like dehydration or anaemia, and sometimes a tilt-table test if fainting needs fuller investigation.
Follow-up & long-term care
If the result is normal and you have no symptoms, no follow-up may be needed. If it is abnormal, your clinician usually reviews your medicines and other possible causes, makes changes, and checks the effect — sometimes repeating the test. Persistent symptoms or falls warrant further review.
- Repeat the test if dizziness, unsteadiness or falls return
- Review medicines regularly, as new tablets can affect standing blood pressure
- Keep up good hydration unless advised otherwise
- Continue simple measures such as standing up slowly
- Re-check after any change in medicines that affect blood pressure
Repeat, follow-on and what comes next
- A single normal test does not rule out the problem, because standing blood pressure varies; repeating it is common.
- An abnormal result usually prompts a medication review and a recheck after changes.
- Unclear results may need a tilt-table test or heart rhythm monitoring.
- Treatment is often adjusted over time as medicines and symptoms change.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of the result and what it means for falls risk and treatment.
- A medication review where a drug may be contributing, with changes explained and followed up.
- Practical advice — standing slowly, staying hydrated, home safety — given in plain language.
- A plan to repeat the test or review symptoms after any changes.
- A named contact for worsening dizziness, falls or blackouts.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether it is done as part of a longer consultation or on its own
- The experience of the clinician carrying it out
- Whether it is done in clinic or at home
- Whether it is repeated or done at different times of day
- Any extra tests arranged to find the cause, such as an ECG or blood tests
- Any follow-up review of medicine changes
- Whether the test is included in a consultation fee or charged separately
- Whether interpretation of the result is included
- The cost of any further tests, such as an ECG or blood tests
- Whether a medication review is included
- Whether a follow-up or repeat test is included
- What happens, and any cost, if the result is unclear and more tests are needed
- The cancellation policy
On the NHS? A lying and standing blood pressure check is a routine NHS test, especially in falls and older people's services; it is also offered privately, but the test itself is the same.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not measuring standing readings at both around one and three minutes, so a delayed drop is missed.
- Treating one normal reading as proof there is no problem.
- Changing or stopping blood pressure medicines without clear explanation or follow-up.
- Not warning the person they may feel dizzy and not having support to hand.
- Failing to look for the underlying cause once a drop is found.
Marketing red flags
- Offering the test as a one-off 'screen' without interpreting it alongside symptoms and medicines.
- Promising to 'cure dizziness' from a single test.
- Selling extra tests that are not indicated.
- Not explaining that results can vary and may need repeating.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Did my blood pressure drop abnormally, and by how much?
- Could any of my medicines be causing this, and should they be changed?
- Should the test be repeated at the time my symptoms are worst?
- What can I do day to day to reduce the dizziness?
- What does this mean for my risk of falls, and how can I lower it?
- What further tests, if any, do I need to find the cause?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does the test hurt?
Why measure lying down and then standing?
What counts as an abnormal drop?
Why might my result be normal even though I feel dizzy?
What usually causes it?
Will I have to change my medicines?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Royal College of Physicians — Measuring lying and standing blood pressure British Geriatrics Society — Lying and standing blood pressure measurement NICE NG249 — Falls in older people: assessment and prevention NHS — Dizziness Orthostatic hypotension — StatPearls (NCBI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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