POTSWhy Blood Pressure Matters in a POTS Stand Test
Heart rate alone cannot separate POTS from orthostatic hypotension. How to measure blood pressure during a stand test and what to record.
The problem with heart rate alone
A fast heart rate on standing can come from two situations. In POTS, blood pressure stays roughly stable while heart rate climbs. In orthostatic hypotension, blood pressure falls and heart rate may rise to compensate. Only blood pressure tells them apart (Freeman 2011).
Heart rate climbs 33 bpm. Systolic pressure holds steady.
HEART RATE (BPM)
SYSTOLIC PRESSURE (MMHG)
Minutes after standing. Switch patterns: the heart rate bars look alike, the pressure dots do not.
The numbers that matter
Orthostatic hypotension means a sustained fall of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing (Freeman 2011). The POTS definition requires that this drop is absent (Freeman 2011, CCS 2020).
How to measure at home
- LyingCuff reading
- Min 1Cuff reading
- Min 2Cuff reading
- Min 3Cuff reading
- Min 5Cuff reading
- Min 7Cuff reading
- Min 10Cuff reading
Upper-arm cuff, arm supported at heart level in both positions.
- Use a validated upper-arm cuff. Wrist cuffs read less consistently when posture changes.
- Keep your arm at heart level in both positions: lean on the wall, bend your elbow, and rest your forearm against your chest.
- Take one reading at the end of the lying rest, then at minutes 1, 2, 3, 5, 7 and 10.
If you cannot take them all, a resting reading plus minutes 3 and 10 still help.
What your doctor does with it
Your clinician reads blood pressure, heart rate, symptoms and history together. The stand test guide covers the whole protocol, and the orthostatic intolerance overview shows where each condition fits.
This page informs and does not diagnose. Only a clinician who can examine you and see your whole history can interpret your numbers.
- Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience. 2011;161(1-2):46-48.
- Raj SR, Guzman JC, Harvey P, et al. Canadian Cardiovascular Society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance. Canadian Journal of Cardiology. 2020;36(3):357-372.
- Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12(6):e41-e63.
- What Is POTS? A Plain-Language Explanation
- How to Test for POTS at Home: The 10-Minute Stand Test
- POTS Symptoms: The Common Ones and What They Mean
- How POTS Is Diagnosed: Criteria, Stand Test and Tilt Table
- NASA Lean Test for POTS: How to Do It at Home
- Do I Have POTS? What to Check Before You See a Doctor
- Tests to Ask For When You Suspect POTS
- Why Does My Heart Race When I Stand Up?
- POTS Heart Rate: How to Graph It with Apple Watch
- Orthostatic Intolerance: Types and How POTS Fits In
- What Is Dysautonomia, and How Does It Relate to POTS?
- What Causes POTS? Subtypes, Triggers and What the Evidence Shows
- POTS and Long COVID: What the Research Shows
- POTS in Teens, Young Adults and During Pregnancy
- POTS Treatment Overview: What Guidelines Recommend First
- Fluids and Salt for POTS: What the Trials Show
- Compression and Exercise for POTS: Two First-Line Treatments
- POTS Medications: What Each One Does and What the Trials Show
- Living With POTS: Triggers, Pacing, Heat, Meals and Sleep
Want a record to bring to your visit? The POTS app guides the stand test at home and graphs your heart rate. See the app