Orthostatic hypotension

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Orthostatic hypotension
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Synonyms	Orthostasis, postural, positional hypotension
Pronounce	N/A
Field	Cardiology, Neurology
Symptoms	symptoms that are worse when sitting or standing and improve when lying down, including lightheadedness, vertigo, tinnitus, slurred speech, confusion, coathanger pain in neck and shoulders, grayed or blurred vision, severe fatigue, fainting or near fainting
Complications	cumulative brain damage, sudden death from falls
Onset
Duration
Types
Causes
Risks
Diagnosis	in-office (lay down for at least 20 minutes, take BP; stand for 3 minutes, take BP), or tilt-table testing by an autonomic specialist
Differential diagnosis
Prevention
Treatment	identify and treat causes (medications, dehydration), midodrine, compression garments, bed tilting
Medication
Prognosis	depends on frequency, severity, and underlying cause; neurogenic orthostatic hypotension is a chronic, debilitating, and often progressively fatal condition
Frequency
Deaths

Orthostatic hypotension (OH) is a type of low blood pressure that occurs upon standing or when changing from a lying or seated position to standing. This transition can cause light-headedness, fainting, and falls, posing a significant health risk, particularly in older adults.

Understanding Orthostatic Hypotension

Orthostatic hypotension is a physical finding defined by the American Autonomic Society and the American Academy of Neurology as a systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg within three minutes of standing.

It's the result of the body's inadequate response to the shift in gravitational stress when moving from a reclining or seated position to standing. Normally, when an individual stands, gravity pulls blood into the lower extremities, leading to a decrease in blood pressure. The body typically compensates by narrowing blood vessels and increasing heart rate to maintain blood flow to the brain. However, in individuals with orthostatic hypotension, these compensatory mechanisms fail, leading to decreased cerebral blood flow and symptoms of cerebral hypoperfusion.

Symptoms and Consequences

People with orthostatic hypotension may experience dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, headache, and syncope (fainting). In severe cases, it can lead to falls and injuries, particularly in the elderly.

Causes and Risk Factors

Orthostatic hypotension can occur for various reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, varicose veins, certain neurological disorders, and advanced age. Certain medications, like diuretics, beta-blockers, and drugs for Parkinson's disease, may also induce orthostatic hypotension.

Diagnosis

The diagnosis of orthostatic hypotension is based on a physical examination, patient history, and the characteristic decrease in blood pressure upon standing. Further tests may be conducted to ascertain the cause of the condition, such as blood tests, electrocardiograms, stress tests, or tilt-table tests.

Treatment and Management

Treatment of orthostatic hypotension focuses on the underlying cause, if identifiable, and symptomatic relief. Depending on the cause, treatment options might involve lifestyle changes, medications, or compression stockings to improve blood flow. It's important to speak with a healthcare provider for an accurate diagnosis and appropriate treatment.

References

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See Also

• Hypotension
• Syncope
• Autonomic nervous system
• Dehydration

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