Standing BP Measures Improve Hypertension Diagnosis


Obtaining standing office blood pressure (BP) measurements improves detection of hypertension, either alone or when added to a seated BP reading, results of a new study suggest.


  • The study included 125 adults, mean age 49 years and 62% female, who were free of cardiovascular disease and had no previous history of hypertension.

  • Researchers collected data on 24-hour ambulatory blood pressure monitoring (ABPM), and three BP measurements in the seated position and then three in the standing position.

  • They assessed overall diagnostic accuracy of seated and standing BP using the area under the receiver operating characteristic (AUROC) curve and considered a Bayes factor (BF) of 3 or greater as significant.

  • They defined the presence of hypertension (HTN) by the 2017 American College of Cardiology/American Heart Association and 2023 European Society of Hypertension HTN guidelines based on ABPM.

  • Sensitivity and specificity of standing BP was determined using cutoffs derived from Youden index, while sensitivity and specificity of seated BP was determined using the cutoff of 130/80 mm Hg and by 140/90 mm Hg.


  • The AUROC for standing office systolic blood pressure (SBP; 0.81; 0.71 – 0.92) was significantly higher than for seated office SBP (0.70; 0.49 – 0.91) in diagnosing HTN when defined as an average 24-hour SBP ≥ 125 mm Hg (BF = 11.8), and significantly higher for seated vs standing office diastolic blood pressure (DBP; 0.65; 0.49 – 0.82) in diagnosing HTN when defined as an average 24-hour DBP ≥ 75 mm Hg (BF = 4.9).

  • The AUROCs for adding standing office BP to seated office BP improved the accuracy of detecting HTN compared with seated office BP alone when HTN was defined as an average 24-hour SBP/DBP ≥ 125/75 mm Hg or daytime SBP/DBP ≥ 130/80 mm Hg, or when defined as an average 24-hour SBP/DBP ≥ 130/80 mm Hg or daytime SBP/DBP ≥ 135/85 mm Hg (all BFs > 3).

  • Sensitivity of standing SBP was 71% compared with 43% for seated SBP.


The “excellent diagnostic performance” for standing BP measures revealed by the study “highlights that standing office BP has acceptable discriminative capabilities in identifying the presence of hypertension in adults,” the authors write.


The study was conducted by John M. Giacona, Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, and colleagues. It was published online September 20, 2023, in Scientific Reports.


As the study enrolled only adults free of comorbidities who were not taking antihypertensive medications, the results may not be applicable to other patients. The study design was retrospective, and the order of BP measurements was not randomized (standing BP measurements were obtained only after seated BP).


The study was supported by the National Institutes of Health. The authors have no relevant conflicts of interest.

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