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Orthostatic hypotension (postural hypotension)

Definition


Disease: Orthostatic hypotension (postural hypotension) Orthostatic hypotension (postural hypotension)
Category: Cardiovascular diseases

Disease Definition:

The type of low blood pressure that occurs when someone stands up from sitting or lying down in called postural or orthostatic hypotension. A person may feel dizzy or lightheaded, and maybe even faint if he/she has this type of hypotension. 

 

Although Orthostatic hypotension more commonly occurs in older adults, but it can occur in anyone. This condition is usually a mild one, lasting for a few seconds to a few minutes at most after standing. Yet, a person should consult a doctor if they often feel lightheaded when standing, for long-lasting orthostatic hypotension could be a sign of more serious problems. In the case of losing consciousness, even momentarily, they have to see a doctor immediately. The affected person might not be in need of a treatment if they have a mild orthostatic hypotension. Several people often feel dizzy or lightheaded after standing, and it’s usually not a matter of concern. Depending on the cause of someone’s low blood pressure, treatment for more severe conditions of orthostatic hypotension can be determined.
 

Work Group:


Symptoms, Causes

Symptoms:

Feeling dizzy or lightheaded when standing up after sitting or lying down is the most common symptom of orthostatic hypotension. This and other feelings often occur shortly after standing up and linger a few seconds or minutes. Signs and symptoms for orthostatic hypotension include:

 

  • Blurry vision
  • Confusion
  • Headache
  • Nausea
  • Feeling dizzy or lightheaded after standing up
  • Fainting (Syncope)
  • Weakness

 

Sometimes lightheadedness or dizziness might be relatively minor, for instance caused by mild dehydration, too much time in the sun or a hot tub, or low blood sugar. Since orthostatic hypotension symptoms could occasionally be a sign of a more serious problem, people experiencing frequent symptoms of this condition should consult a doctor. Keeping a record of the symptoms, such as when and where they take place could be helpful, especially when they occur at times that might endanger the patient or others.
 

Causes:

Blood pressure is decreased by the gravity causing blood to pool in the legs when standing up, because there will be less blood circulating back to the heart to pump. Naturally, special cells called baroreceptors, located next to the heart and neck arteries sense this lower blood pressure and counteract it by triggering the heart to beat faster and pump more blood stabilizing blood pressure. Additionally, these cells cause blood vessels to narrow increasing resistance to blood flow and increasing blood pressure.

 

When something interrupts the body’s natural procedure of counteracting low blood pressure, orthostatic or postural hypotension occurs. Orthostatic hypotension could be the result of various factors, such as:

Dehydration:

Dehydration may be caused by not drinking enough fluids, severe diarrhea, fever, vomiting and strenuous exercise. When someone becomes dehydrated, the body losses more water, and usually sodium, than it takes in. Weakness, fatigue and dizziness may be caused by even mild dehydration.

Diabetes:

Orthostatic hypotension may result in case dehydration that leads to frequent urination is caused by untreated diabetes.
Plus, the nerves that help send signals regulating blood pressure may be damaged by diabetes.

Heart problems:

Extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure are some of the heart conditions that could contribute to low blood pressure. By preventing enough blood to circulate in a person’s body, these conditions may end up causing orthostatic hypotension.

Nervous system disorders:

Some diseases that could disrupt a person’s body’s normal blood pressure regulation system include Parkinson’s disease, multiple system atrophy (Shy-Drager syndrome) and amyloidosis.

 

Orthostatic hypotension has risk factors, such as:

Age: 

Most cases of orthostatic hypotension happen in the ages of 65 and older. The ability of special cells (baroreceptors) near the heart and neck arteries regulating blood pressure could be slowed as the body ages. Additionally, it might be more difficult for the heart to beat faster and compensate for drops in blood pressure when someone ages.

Certain diseases:

Some heart conditions and Parkinson’s disease put the affected person at a greater risk of developing low blood pressure.

Medications:

Blood pressure medications could increase the risk of being affected by orthostatic hypotension, such as:

 

  • Dildenafil, especially when taken in combination with nitroglycerin
  • Medications for Parkinson’s disease
  • Narcotics
  • Beta blockers or other heart medications
  • Tricyclic antidepressants
  • Alcohol
  • Medications that treat high blood pressure, such as diuretics
  • Other prescription and over-the-counter medications when taken in combination with drugs used to treat high blood pressure.
Heat exposure: 

Being in a hot environment could make someone sweat and, possibly, lead to dehydration that could lower the blood pressure and trigger orthostatic hypotension.

Pregnancy:

Blood pressure is likely to drop when a woman’s circulatory system expands quickly throughout pregnancy. This could cause blood pressure to become low enough to result in orthostatic hypotension when standing up hurriedly.

Crossing the legs at the knees:

Sitting for a long time with the legs crossed at the knees (versus ankle across the knee, as men are prone to do) presses on veins, making blood pool in the leg.

Bed rest:

A person may become weak in case he/she has to stay in bed for a long period of time because of a disease. The person may experience orthostatic hypotension when trying to stand up.
 

Complications

Complications:

When mild types of orthostatic hypotension might seem only annoying, more serious complications are possible, specifically in older adults. Such as:

Stroke:

Someone’s risk of stroke increases due to the swings in blood pressure when standing and sitting caused by orthostatic hypotension.  

Brain Damage: 

Parts of the brain may be damaged due to repeated episodes of orthostatic hypotension, which may increase the risk of some forms of dementia as well as other brain disorders.

Falls:

One of the common complications in people with orthostatic hypotension is falling down as a result of fainting (syncope). 
 

Treatments:

The underlying cause of orthostatic hypotension will determine its treatment. Rather than addressing the low blood pressure itself, the doctor will try to treat the underlying cause, such as heart failure or dehydration.

 

Sitting or lying down immediately after feeling lightheaded upon standing is one of the simplest treatments of mild orthostatic hypotension. Usually, the symptoms of orthostatic hypotension go away.

 

Medications resulting in low blood pressure are often treated by changing the dose of the medication or stopping it for good. There are various alternatives for the treatment of orthostatic hypotension, such as:

Lifestyle changes: 

Drinking little to no alcohol; drinking plenty of fluids like water, keeping off walking throughout hot weather, and standing up slowly are things the doctor may recommend. To strengthen the calf muscles of the patient, the doctor might also advise exercise programs. The patient may also be suggested increasing the amount of salt in their diet in case they don’t have high blood pressure.

Medications: 

Orthostatic hypotension could be treated with medication, either taken alone or in combination.
For instance, the medication fludrocortisones is frequently used to help raise the amount of blood, which in turn raises blood pressure. To raise the levels of standing blood pressure, the drug midodrine is usually used because it limits the ability of the blood vessels to expand, increasing the blood pressure. Other medications such as pyridostigmine, nonsteroidal anti-inflammatory drugs (NSAIDs), caffeine and epoetin, are also occasionally used, either alone or together with other medications.

Compression stockings:

The pooling of blood in the legs may be decreased and the symptoms of orthostatic hypotension lessened with the use of the same elastic stockings and leotards that relieve the pain and swelling of varicose veins.
 

Prognosis:

Not available

Expert's opinion

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