Table 2 Studies included in meta-analysis for consensus definition of postural hypotension

  Hommel 2016 [22]

Male and female nursing home residents in the Netherlands, receiving long term care and using antiparkinsonian medication

78.8

After 10 min of supine rest and at 1 and 3 min after standing up, BP was measured using a routine sphygmomamometer

  Enrique Asensio 2011 [23]

Male and female Mexican residents of public or private care institutions, aged over 65 years and able to sign informed consent

82.4

After 5 min of seated rest and at 1 and 3 min of standing up, BP was measured using an aneroid oscillometric sphygmomanometer

  Valbusa 2012 [24]

Male and female nursing home residents in France and Italy, aged over 80 years and able to sign informed consent

88

After 10 min of seated rest and at 1 and 3 min of standing up, BP was measured using the Colson DM-H20 automated oscillometric device (Dupont Médical, Frouard, France). All measurements were repeated three times, with intervals of 3 min on the left arm in a sitting position

  Bouhanick 2014 [25]

Male and females living in France with type 2 diabetes, aged over 70 years with relatively preserved autonomy (Activity of Daily Living Score > 3/6)

77.0

After 5 min of supine rest and at 1, 3 and 5 min after standing up, BP was measured. The BP device was not stated

  Fleg 2016 [26]

Male and female participants with type 2 diabetes and a glycohaemoglobin level ≥ 7.5%, aged 40–79 years with cardiovascular disease or aged 55–79 years with anatomic evidence of subclinical atherosclerosis, albuminuria, left ventricular hypertrophy or ≥ 2 additional risk factors for cardiovascular disease, attending 77 sites across the U.S.A and Canada

40.0–79.0

BP was measured three times, at 1 min intervals, after 5 min of seated rest and on standing, using an automated oscillometric device (Omron HEM-907; Omron Healthcare Co. Kyoto, Japan)

  Hirai 2009 [27]

Male and female participants with type 1 or 2 diabetes living in Wisconsin

45.4

BP was measured using a standard mercury sphygmomanometer during supine rest and repeated within 3 min after participants were asked to stand up

  Klanbut 2018 [28]

Male and female participants with Parkinson’s disease (Hoehn and Yahr stage I-IV), stable on drug therapy or not received any drug modifications for 4 weeks prior to enrolment, attending King Chulalongkorn, Thailand

65.5

After 10 min of seated or supine rest, and within 3 min of standing, BP was measured using an automated sphygmomanometer (Omron HEM-7200)

  Kleipool 2019 [29]

Male and female participants (from the Amsterdam Dementia cohort) with subjective cognitive decline, mild cognitive impairment or dementia attending a memory clinic.

63.9

After 5 min of supine rest, and at 1 and 3 min after standing, BP was measured. The BP device was not stated

  Merola 2016 [30]

Male and females with idiopathic Parkinson’s disease (Hoehn and Yahr stage I-IV), aged 30–85 years, on dopaminergic treatment for at least 4 weeks prior to study enrolment, attending two specialised Movement Disorder Centres in the USA and Italy

30.0–85.0

After 10 min of seated and supine rest and at 1 and 3 min after standing, BP was measured in the left arm using an automated sphygmomanometer (Omron, HEM-7200; Omron Healthcare Co. Kyoto, Japan). The average of two BP measurements were used for both seated and supine rest

  Romagnolo 2019 [31]

Male and female participants, with idiopathic Parkinson’s disease, aged between 30 and 85 years old, attending a Movement Disorder Center in Italy. Participants must have been taking stable doses of dopaminergic treatment for at least 4 weeks prior to enrolment in the study

65.06

BP was measured after 10 min supine rest and at 1, 3 and 5 min after standing using a mercury sphygmomanometer

  Sonnesyn 2009 [32]

Male and female participants with first time diagnosis of mild dementia (mini mental state score of at least 20) with referrals to outpatient clinics in geriatric medicine, old age psychiatry and neurology and living in Norway

n/a

After supine rest (or in some cases, seated rest) and then once within 3 min of standing, BP was measured using an analogue sphygmomanometer

  Wecht 2016 [33]

Male and female veterans attending an urban Medical Centre, U.S.A

21.0–88.0

After 10 min supine rest and during 10 min of standing, BP was measured in the right arm at 1 min intervals using an automated sphygmomanometer (Dynamap Pro 300; GE Healthcare, Buckinghamshire, UK)

  Alli 1992 [34]

Male and female participants aged over 65 years, attending general practices in Italy

72.7

BP was measured in the sitting position, after 5 min of supine rest and 30 s after standing up using a mercury sphygmomanometer

  Atli 2006 [35]

Male and female participants aged over 65 years, attending the outpatient clinic of Ankara University School of Medicine, Department of Geriatric Medicine, Turkey

68.0

After 20 min of supine rest and 3 min after standing, BP was measured using a manual sphygmomanometer

  Bengtsson Lindberg 2015 [36]

154 male and female dementia patients (50 with Alzheimer’s disease, 54 with Alzheimer’s disease with vascular components, 50 with dementia with Lewy bodies) attending a Memory Clinic and 50 controls, in Sweden

n/a

After 10 min of supine rest, immediately after standing and at 1, 3, 5 and 10 min of standing, BP was measured using a validated digital sphygmomanometer (Omron M5–1; Omron Healthcare Co. Kyoto, Japan)

  Clara 2007 [10]

Male and female participants aged over 55 years, living in Portugal, attending primary healthcare centres in the community

n/a

After 5 and 7 min of seated rest, and at 2 and 5 min after standing, BP was measured using a calibrated mercury sphygmomanometer

  Hiorth 2019 [37]

Male and female participants, with incident, drug-naïve Parkinson’s disease, residing in Southern and Western Norway

67.8

BP was measured in a supine position and after 1 min of standing, using a manual sphygmomanometer

  Kamaruzzaman 2010 [38]

Females aged 60–80 years of age, living in the U. K and attending general practices

60.0–80.0

Two sitting BP measurements, followed by two standing measurements were recorded at 1 min intervals. The BP device was not stated

  Liepelt Scarfone 2015 [39]

Male and female patients with Parkinson’s disease, aged over 50 years, attending the outpatient clinic of the Department of Neurodegeneration, University of Tübingen, Germany

>  50.0

After 2 min supine rest and after 2 min of standing, BP was measured manually

  Liu 2016 [40]

Male and female participants attending a community health centre in Chengdu, China

64.8

After 5 min of seated rest, BP was measured in the right arm, twice (at 1 min apart) using a calibrated electronic device (Omron HEM-7200; Omron Healthcare Co. Kyoto, Japan). After 10 further min of supine rest, and at 30 s and 2 min after standing, BP was recorded again and these measurements were used to determine postural hypotension

  Masuo 1996 [41]

Individuals living in Japan, aged ≥65 years with normotension (≤ 140/90 mmHg) or established hypertension (160/95 mmHg) treated with calcium channel blockers, beta blockers, alpha blockers, angiotensin converting enzyme inhibitors or diuretics after a 1 month placebo run-in period

≥ 65.0

BP was measured after 5 min of seated rest, 10 min supine rest and after standing for 2 min (in this order). The BP device was not stated

  Oishi 2016 [42]

Male and female patients, aged over 70 years, who visited a hospital in Japan for day care, programmed for those with dementia

84.0

BP was measured using a validated electronic device (Parama-Tech PS-501) in the supine position after a few minutes of rest and immediately on standing and at 1, 3 and 5 min after standing

  Perez Orcero 2016 [43]

Male and female patients, aged over 80 years, able to stand for 5 or more minutes and attending an urban primary health care centre or treated at home by a family doctor or nurse were included

85.2

After 5 min of rest in the supine position, 2 separate BP readings were taken 1 min apart, and then BP was measured immediately on standing and at 1, 3 and 5 min after standing, using a validated and calibrated oscillometric Omron 705-CP device (Omron Healthcare Co. Kyoto, Japan)

  Van Hateren 2012 [44]

Male and female patients, aged ≥70 years, with type 2 diabetes attending general practices in the Netherlands

75.0

After 5 min of rest, two BP measurements were performed in the supine position and at 1 and 3 min following standing, using a validated A&D digital monitor (UA-767 plus 30). The mean of the two measurements at each time point was calculated

  Walczak 1991 [45]

Male and female individuals, aged 63–93 years attending a day centre

63.0–93.0

After 20 min of supine rest and after 2 min of standing, BP was measured using a standard sphygmomanometer

  Zhu 2016 [46]

Multiethnic Asian ambulatory male and female patients, aged ≥65 years, attending a typical public primary care clinic located in the mideastern part of Singapore

74.6

After 5 min of supine rest, BP was measured 3 times in the right arm. In addition, BP was measured at 1 and 3 min following standing using a calibrated DINAMAP BP machine (Procare 100; GE Healthcare, Little Chalfont, Buckinghamshire, UK)

  Cremer 2017 [47]

Male and female participants, aged over 65 years, living in three cities in France (Bordeaux, Dijon and Montpellier.)

>  65.0

After 5 min of supine rest and immediately on standing, BP was measured once using an automated oscillometric device (Omron CP750, Omron Healthcare Co. Kyoto, Japan)

  Drozdz 2016 [48]

Male and female participants, aged over 18 years, with New York Heart Association class II-III chronic heart failure, with left ventricular ejection fraction < 40% under stable conditions, with no cardiovascular interventions in the past 3 months and stable on pharmacological treatment in the 4 weeks prior to study enrolment

63.3

After 10 min of supine rest and within 3 min of standing, BP was measured using a validated oscillometric device (Omron M6; Omron Healthcare Co. Kyoto, Japan)

  Foster-Dingley 2018 [49]

Male and female participants, aged at least 75 years, using antihypertensive medication, with a systolic BP 160 mmHg or less and a Mini Mental State examination score of 21–27. Participants were residing in the Netherlands and did not have serious cardiovascular disease or a clinical diagnosis of dementia

81.0

After 5 min of seated rest, BP was measured twice (separated by 1–2 min) and within 3 min of standing, BP was measured 3 times, on the right arm. An automatic electronic sphygmomanometer (Omron M6 comfort; Omron Healthcare, Inc., Lake Forest, Ilinois, USA)

  Hiitola 2009 [50]

Male and female home-dwelling participants, aged over 75 years, living in Kuopio in Eastern Finland

81.0

After 10 min of rest, BP was measured in the supine, seated and standing positions (at 1 and 3 min) by a trained nurse using a calibrated mercury column sphygmomanometer

  Kartheek 2011 [51]

Male and female participants, aged 20–90 years, of mixed socioeconomic status, living in Kurnool and Kadapa district urban areas of India. Participants were non-smokers and free of any cardiorespiratory disease

20.0–90.0

BP was measured in the right arm using a mercury sphygmomanometer after 5 min of supine rest and at 1 and 3 min following standing. The average of two readings were taken to determine BP

  Mendez 2018 [52]

Male and female participants aged over 55 years, residing in Venezuela

66.7

BP was measured in the supine position and at 1 and 3 min after standing using the same oscillometric device (Dinamap 8100, Critikon Inc., Tampa, FL, USA)

  Nguyen 2017 [53]

Male and female participants, aged 60 years or older, able to communicate and sit and stand in 3 min, residing in Ben Tre, a Southern Province Vietnam

70.4

After at least 15 min of rest, two seated BP measurements were obtained, separated by 5 min. The mean of the two sitting BPs were used for analysis. BP measurements were repeated after standing for 3 min. BP was measured using a calibrated Omron electronic sphygmomanometer (model HEM 7130, OMRON Corp, Kyoto, Japan)

  Putnam 2018 [54]

Male and female participants, aged 70 years or older, residing in Tanzania

72–80

BP was measured using a calibrated A&D Medical UA-1020 Digital BP monitor in the supine position, followed by 30 s, 1, 2 and 3 min after standing

  Rockwood 2012 [55]

Elderly male and female participants living in Canada

83.2

BP was measured in supine and standing positions (or seated in those unable to stand) within 3 min using a sphygmomanometer

  Veronese 2014 [56]

Male and female participants, aged ≥65 years, living in Italy

73.8

BP was measured 3 times in the right arm, with 30 s between each measurement, using a mercury sphygmomanometer (Erkameter 300) with subjects in a supine position. BP measurements were also recorded at 1 and 3 min after standing

  Wolters 2016 [57]

Male and female participants, aged ≥55 years, from the Ommoord area, a suburb of Rotterdam, Netherlands

68.5

After 5 min of supine rest, the mean of 2 BP measurements were recorded. BP was also recorded following 1, 2 and 3 min of standing using an automatic machine (Dinamap, Critikon)

  Assantachai 1998 [58]

Male and female participants, aged over 60 years, living in Bangkok and able to perform postural change from lying to standing by themselves

60.0–96.0

After 10 min of supine rest, BP was measured twice using a digital sphygmomanometer. BP was then recorded twice during 1–2 min of standing,

  Bell 2016 ARIC [59]

Male and female participants, aged 45–64 years, living in 4 U.S.A communities: Forsyth County, Jackson, suburban Minneapolis and Washington County

54.0

After 20 min of supine rest, BP was measured every 30 s for 2 min (2–5 measurements, 90% of participants had ≥4 measurements) using a Dinamap 1846 SX automated oscillometric device. BP was then measured repeatedly for the first 2 min after standing (2–5 measurements, 91% of participants had ≥4 measurements)

  Bell 2016 CHS [59]

Male and female community-dwelling individuals, aged over 65 years, living in 4 U.S.A communities: Pittsburgh, Forsyth County, Sacramento County and Washington County

73.0

After at least 20 min of supine rest and after 3 min of standing, BP was measured using a mercury sphygmomanometer (Baumanometer, W.A. Baum, Copiague, NY)

  Cilia 2015 [60]

Male and female patients with Parkinson’s disease for ≥20 years

n/a

BP protocol or device not reported

  Cohen 2015 [11]

Male and female participants, aged over 65 years, independent in ambulation and attending a primary care clinic in Israel

73.6

BP was measured every min during 10 min of supine rest and within 1 min of standing and repeated at 1 min intervals another 6 times. BP was measured using an automatic Scholar III 507 EL monitor (CSI - Criticare Systems, Inc.)

  Curreri 2016 [61]

Male and female community-dwelling individuals, aged ≥65 years, living in Camposampiero and Rovigo, Italy

71.4

After at least 5 min of supine rest, BP was measured 3 times in the right arm, at 30 s intervals, using a mercury sphygmomanometer (Erkameter 300). BP was then measured after 1 and 3 min of standing

  Ensrud 1992 [62]

Female participants, aged over 65 years, residing in the U.S.A: Portland, Minneapolis, Baltimore and Monongahela Valley, near Pittsburgh

71.7

After 5 min of supine rest and after 1 min of assuming a standing position, BP was measured in the right arm using a Baum mercury sphygmomanometer

  Fan 2010 [63]

Male and female rural community residents, aged 40–75 years, living in Xinyang County, China

40.0–75.0

After 15 min of supine rest, BP was measured 3 times in the right arm at 30 s intervals and at 30 s and 2 min after standing

  Fedorowski 2010 [64]

Middle-aged male and female individuals, living in Sweden

45.7

After 10 min of supine rest and at 1 min after standing up, BP was measured using a mercury sphygmomanometer

  Frewen 2014 [65]

Community-dwelling male and female individuals, aged over 50 years, living in the Republic of Ireland

63

After 30 min of seated rest, 2 BP measurements were recorded, separated by 1 min, using an automatic digital BP monitor (Omron M10-IT; Omron Healthcare Co. Kyoto, Japan). After 1 min of standing, a single BP measurement was also recorded

  Gangavati 2011 [66]

Male and female individuals, aged over 70 years, who were able to understand and communicate in English, walk 20 ft. without assistance and living in Boston, U.S.A

78.1

After 5 min of supine rest, 2 BP measurements were recorded, separated by 1 min, using a standard sphygmomanometer. The mean of the 2 measurements were used for analysis. BP was also recorded at 1 and 3 min after standing

  Lampela 2013 [67]

Male and female participants, aged ≥75 years, living in Kuopio, Finland, including mainly home-dwelling individuals, but part of the sample were living in institutional care

≥ 75.0

BP was measured after 10 min of rest in the supine position, 1 min after sitting and after 1 and 3 min of standing using an electronic sphygmomanometer or mercury where needed (e.g. if atrial fibrillation was present)

  Luukinen 1999 [68]

Male and female home-dwelling participants, aged over 70 years, living in 5 rural municipalities in northern Finland

76.0

After 5 min of supine rest and at 1 and 3 min after standing up, BP was measured in the right arm using a mercury manometer

  Luukkonen 2017 [69]

Male and female home care clients, aged over 75 years, living in Eastern and Central Finland

84.5

After 10 min of supine rest, the first BP was measured. The second BP was measured in the seated position, followed further BP measurements at 1 and 3 min after standing using an automated BP device

  Mader 1987 [70]

Independent, community living individuals, aged over 55 years who utilise the free health screening services of Santa Monica Senior Health and Peer Counseling Center, U.S.A

69.8

After 5 min of supine rest, 3 BP measurements were recorded over a 5 min period using a mercury manometer (Baumanometer). The mean of the second and third BP measurements were used. BP was also measured 1 min after standing

  Masaki 1998 [71]

Males of Japanese ancestry, aged 45–68 years and living on the island of Oahu, Hawaii

71–93

After at least 15 min of supine rest and after 3 min of standing, BP was measured using a standard mercury sphygmomanometer

  O’Connell 2015 [72]

Community-dwelling male and female individuals, aged over 50 years, living in the Republic of Ireland

63.0

After at least 30 min of seated rest, 2 BP measurements were recorded and the mean was used for analysis. A single BP measurement was also recorded after 1 min of standing using an automated BP device (Omron M10-IT; Omron Healthcare Co. Kyoto, Japan)

  Ong 2017 [73]

Male and female individuals, aged over 60 years, living in the community (day care centres, nursing homes and institutions were included) who were citizens or permanent residents in Singapore

> 60.0

Two sitting BP measurements were recorded and the mean was used for analysis. Standing BP was also measured after 2 min using a standard electronic sphygmomanometer (Omron HEM-7211; Omron Healthcare Co. Kyoto, Japan)

  Shin 2004 [74]

Male and female Korean individuals, aged 40–69 years, living in an industrialised community 32 km southwest of Seoul, South Korea (Ansan) and in a rural setting, 100 km south of Seoul (Ansung)

40.0–69.0

After at least 5 min of supine rest, BP was measured 3 times at 30 s intervals and the mean was used for analysis. Standing BP measurements were recorded at 0 and 2 min after standing

  Vanhanen 1996 [75]

Male and female individuals, aged over 60 years, with isolated systolic hypertension (sitting SBP 160–219 mmHg, DBP < 95 mmHg and a standing SBP ≥ 140 mmHg)

70.0

BP was measured twice after 2 min of rest in the supine position, twice after 5 min of rest in the seated position and twice after 2 min in the standing position using conventional sphygmomanometry

  Velilla Zancada 2017 [76]

Male and female individuals, aged over 18 years, living in Cantabria, Spain

48.5

After 5 min of rest, 3 BP measurements in the dominant arm were recorded in the sitting position using the validated and semiautomatic device (Omron 705 CP; Peróxidos Farmacéuticos S.A. Barcelona, Spain) and the mean of the final 2 measurements were used for analysis. BP was also measured at 1 and 3 min after standing

  Viramo 1999 [77]

Male and female, home-dwelling and institutionalised individuals, born in 1920 or earlier and living in 5 rural municipalities around the town of Oulu, Northern Finland

> 70.0

After 5 min of supine rest and at 1 and 3 min after standing, BP was measured in the right arm. The BP device was not stated

  Wu 2009 [78]

Male and female community-dwelling individuals, with normal glucose tolerance, pre-diabetes and diabetes, aged ≥20 years, living in Tainan, a city in southern Taiwan

≥ 20.0

Two seated BP measurements were recorded, with at least 5 min intervals, after at least 15 min rest using a DINAMAP vital sign monitor (model 1846SX; Critikon, Irvine, CA). BP was also measured twice in the supine position followed by measurements at 1 and 3 min after standing

  Yap 2008 [79]

Male and female individuals, aged over 55 years, living in the south-east region of Singapore

65.5

After at least 10 min of rest, BP was measured up to 3 times, at 30 s intervals, in the right arm in the supine, seated and standing positions using a standard mercury sphygmomanometer. The mean of the two closest readings was used for analysis