Orthostatic vitals are underused and frequently done wrong

The textbook teaching is to check BP/HR lying down, then standing at 1 and 3 minutes. In practice, most clinicians check once, immediately upon standing, and call it done. That single early check catches initial orthostatic hypotension but misses delayed orthostatic hypotension, which doesn't show up until 3–5 minutes and is common in older adults, autonomic dysfunction (Parkinson's, diabetic autonomic neuropathy), and patients on vasodilators or diuretics.

Why it matters clinically: a patient with unexplained falls, syncope, or "dizziness on standing" who has a normal 1-minute orthostatic check can still have significant delayed drops. If your clinical suspicion is high, repeat the standing BP at 3 minutes before writing off orthostasis as a cause.

Bonus pearl embedded in this one: a rise in heart rate of ≥30 bpm with standing but no drop in BP should make you think POTS (postural orthostatic tachycardia syndrome), especially in younger patients — a very different diagnostic and management path than classic orthostatic hypotension.