Orthostatic Hypotension

1 What is Orthostatic Hypotension?

Orthostatic hypotension or postural hypotension is kind of low blood pressure, which occurs upon standing up from a sitting or lying position. Usually a mild case, orthostatic hypotension may last for a few seconds to several minutes after the shift in position.

If the orthostatic hypotension lasts longer, it can be an indication of a more complicated health issue. If the symptoms are accompanied by loss of consciousness, consult your doctor as soon as possible.

While mild cases do not usually require treatment, some people experience more severe symptoms that call for immediate medical attention.

2 Symptoms

Orthostatic hypotension’s most common symptom is the dizziness or lightheadedness that comes upon standing up from a sitting or lying position. This, together with other symptoms, may last for a few seconds.

Other signs and symptoms of orthostatic hypotension include:

The dizziness or lightheadedness that usually come with the condition is relatively minor, which can be caused by several factors. If the symptoms rarely happen, they do not have to cause an alarm. However, if the symptoms become more pronounced and frequent, you have to see a doctor since these may mean a more serious condition.

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3 Causes

Orthostatic hypotension is mainly caused by a decreased blood pressure due to interruption of the body’s ability to counteract low blood pressure. This occurrence is usually caused by:

  • Dehydration: Dehydration may be due to fever, severe diarrhea, vomiting, strenuous exercise, excessive sweating, and not drinking enough fluids. Dehydration causes the body to lose blood volume. The common symptoms of orthostatic dehydration, such as dizziness and weakness, are often a result of mild dehydration.
  • Heart problems: Certain heart conditions, such as bradycardia (extremely low heart rate), valve problems, heart failure and heart attack , can lead to hypotension. These conditions prevent the body from pumping enough blood to the heart when needed, thus causing orthostatic hypotension.
  • Endocrine problems: Several endocrine issues like thyroid conditions, low blood sugar, Addison’s disease, and diabetes can cause low blood pressure.
  • Nervous system disorders: Parkinson’s disease, Lewy body dementia, multiple system atrophy, amyloidosis, and pure autonomic failure are disorders of the nervous system that alter the ability of the body to regulate the blood system.
  • After meals: In rare cases, low blood pressure is experienced after meals. This is called postprandial hypotension and is more common in the elderly.

4 Making a Diagnosis

Making a diagnosis of orthostatic hypotension is done during physical examination and by performing several tests.

While special preparations are not necessary prior to check up, it would be ideal to write down all important information that have something to do with your symptoms. Doing this will maximize your time with the doctor and also prevent you from forgetting any vital details. Make a list of the symptom you are experiencing, together with the list of medications, vitamins, and supplements that you are taking.

Also, write down your family medical history, major stresses and recent life changes. It will also be ideal to make a list of questions you like to ask the doctor.

Your doctor, on the other hand, may also ask you a few questions as well. Responding with true and honest answers is the key to a proper diagnosis. The doctor will also do a physical examination and several tests to diagnose your condition properly. Certain blood tests, blood monitoring, electrocardiogram, echocardiogram, and stress test may be performed.

In addition to these test, a tilt table test may also be performed. This involves lying down a flat table and tilting it to stimulate lying to standing up maneuver. While doing this movement, your blood pressure will be monitored.

5 Treatment

Orthostatic hypotension treatment depends on what is causing it. The first thing that the doctor would do is to address the underlying condition. While most mild cases of this condition do not require treatment, your doctor may suggest sitting or lying down when lightheadedness attacks.

Treatment for orthostatic hypotension may include:

  • Changes in lifestyle: Several lifestyle changes, such as drinking more fluids, avoiding spending extended time under the sun, limiting alcohol intake, and lying on the bed with the head elevated can help minimize the symptoms. In addition, your doctor may ask you to do exercises that can strengthen the leg muscles. Increasing salt intake may also be suggested if you do not have high blood pressure.
  • Compression stockings: Wearing compression stockings and clothes may reduce blood pooling in the legs and minimize the symptoms of this condition.
  • Medications: Certain medications, such as midodrine, can be used to raise the blood pressure levels when standing. If the condition is associated with issues of the nervous system, such as Parkinson’s disease, your doctor may prescribe droxidopa. Other medications commonly prescribed to treat this condition are pyridostigmine, NSAIDs, epoetin, and caffeine. These medications can either be used alone or in combination.

6 Risks and Complications

There are several risks and complications associated with orthostatic hypotension.

Risk factors for orthostatic hypotension:

  • Age. People aged 65 and above are more prone to this condition.
  • Medications. Certain medications may increase your risk of having orthostatic hypotension.
  • Certain diseases. Some heart ailments and nervous system disorders may heighten your chance.
  • Hot weather. Heat exposure may cause dehydration, which could trigger this condition.
  • Pregnancy. When pregnant, your blood pressure is likely to drop due to a rapidly expanding circulatory system.
  • Alcohol consumption. Drinking alcohol can lower your blood pressure, thus increase your risk of orthostatic hypotension.

The condition may also cause complications, such as:

  • Falls. Some people with hypotension faints that can cause falling down.
  • Stroke. Abnormal blood pressure swings can cause decreased supply of blood to the brain. This occurrence can result to stroke, especially in the elderly.
  • Cardiovascular diseases. Chest pains, heart rhythm problems, and heart failure are some cardiovascular disease and complications that may result from orthostatic hypotension.
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