Authors (including presenting author) :
Law TC(1), Kwong HK(1), Chow K(1), Wong Y(1), Leung B(1), Leung SH(1), Li WSV(1), Ko SH(1)
Affiliation :
(1) Department of Family Medicine & Primary Healthcare, Kowloon Central Cluster
Introduction :
The Population Health Survey 2014 - 15 of the Department of Health revealed that the prevalence of Hypertension (HT) increased with advancing age and up to 64.8% for those aged 65 to 84 have HT. However, hypotension developing under antihypertensive (anti-HT) medication use has been indicated as a potential risk factor for morbidity and mortality in older adults. There were cases of patient fall and we found their blood pressure (BP) were low even immediately after the injury. In order to assesses patient at risk of postural hypotension, a standardized Supine and Erect blood pressure measurement was in place at General Outpatient clinics (GOPC) of Kowloon Central Cluster (KCC).
Objectives :
- Detection of postural hypotension and early intervention before accident happen because of the postural hypotension
- Standardize process of checking postural hypotension and patient education by nurse for those patients with postural hypotension
- Bring awareness to clinic staffs on management of patient at risk of hypotension
Methodology :
- Doctor used internal communication sheet to ask nurse to check Supine and Erect BP for patient suspected to have postural hypotension.
- Patient was asked to lie supine for 5minutes and BP checked as supine BP.
- Patient was asked to stand upright for 1minute and BP checked as 1min erect BP.
- Patient was asked to stand till 3minute and BP checked again as 3min erect BP.
- If patient had symptoms and there was drop in BP, patient will have another BP check at 5min of total standing as long as patient remain physically capable.
- Patient will be given a communication sheet on result and continue consultation with doctor. Systolic BP drop >=20mmHg or diastolic BP drop >=10mmHg implied orthostatic hypotension.
- Patient will be given talk and pamphlet on fall prevention by nurse and follow up session by nurse will be arranged if need.
Result & Outcome :
From 1st September to 31 December 2024, totally 45 patients had their Supine and Erect BP checked.
3 out of them were found to have orthostatic hypotension. They were 46 to 76 years old. They were on 2 to 4 anti-HT agents. All of them had other medical co-morbidities, namely diabetic mellitus, hyperlipidemia, atrial fibrillation and Parkinson's disease. These patients’ chronic medicines were adjusted and they received a nurse talk on prevention of postural hypotension.
The remaining 42patients without orthostatic hypotension confirmed by checking the supine and erect BPs were age 23 to 94 years old. 23 of them were not on any anti-HT agent while 19 of them were on 1 to 4 anti-HT agents. 10 of them have their anti-HT agent started or chronic medicine dose adjusted according to their clinically needs after their supine and erect BP checked.
Conclusion:
- Supine and erect BP are important clinical information to guide us in medical management when patient complained dizziness on postural change.
- Even patient was just on 2 anti-HT, orthostatic hypotension can happen, especially when patients have other co-morbidities. High level of suspicious, early detect and timely adjustment of medicine can help to prevent accident.
