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bjgp.org

Background Postural hypotension is associated with cognitive decline, falls, and all-cause mortality, representing a substantial burden on the NHS. Postural hypotension is often asymptomatic, making detection and treatment difficult. Currently, there is no systematic approach to measuring and managing postural hypotension in UK general practice. Aim To explore barriers to and facilitators of improving postural hypotension measurement and management. Design and setting This was a qualitative interview study with healthcare practitioners (HCPs) in general practices in England. Method Individual, remote, semi-structured interviews were conducted with a range of HCPs who measure blood pressure in general practice to explore their views and experiences of measuring and managing postural hypotension. Participants were identified from expressions of interest during a national survey. Interviews were video- and audio-recorded, transcribed verbatim, and analysed thematically. Results In total, 26 HCPs in 24 practices across nine clinical research networks in England were interviewed between March and July 2023. HCPs checked for postural hypotension when patients were older, reported dizziness, fatigue, or had chronic conditions. Despite awareness of clinical guidelines, various diagnostic definitions were provided and measurement protocols varied between participants. Sit-to-stand rather than supine-to-stand measurements were considered more feasible owing to time constraints and patient mobility. Education and training, as well as incentives and specialist clinics, were suggested as methods to improve postural hypotension measurement and management. Conclusion This is the first study, to our knowledge, to explore barriers to and facilitators of postural hypotension measurement in English general practice. Findings suggest a more systematic approach to measurement is needed to improve detection and management of postural hypotension in general practice.

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