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Orthostatic Hypotension

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Overview of Orthostatic Hypotension

Orthostatic hypotension (استادَہ وَضعی ادنی دباو/آرتھوسٹک ہائپوٹینشن) also termed as postural hypotension. This condition occurs due to low blood supply to the heart because most of the blood gets accumulated in the lower body parts. Orthostatic hypotension causes dizziness and lightheadedness.

Mild orthostatic hypotension persists only for a few minutes. However, long-term dizziness can be serious and require immediate medical care.

Signs and Symptoms of Orthostatic Hypotension

Some common signs and symptoms of orthostatic hypotension are:

 

  • Lightheadedness or dizziness upon standing
  • Weakness
  • Blurry vision
  • Fainting (syncope)
  • Nausea
  • Confusion

 

Types of Orthostatic Hypotension

There are two types of orthostatic hypotension based on the cause, including:

  • Acute Orthostatic Hypotension: This is caused by prolonged bed rest as a result of any illness or dehydration.
  • Chronic Orthostatic Hypotension: This type of hypotension is usually a sign of any underlying condition.

Causes of Orthostatic Hypotension

In the standing position, most of the blood is pulled into the legs and abdomen due to gravity. This causes a drop in blood pressure because less blood is circulated back to the heart.

Baroreceptors are special types of cells present near the heart or neck region that sense lower blood pressure. These cells signal the control center in the brain, which in return signals the heart to pump more blood to stabilize the blood pressure. When this counteracting process is disturbed, the condition is called orthostatic hypotension. It can be caused by various reasons such as:

  • Heart Problems: Some heart problems can cause a drop in blood pressure such as:
    • Extremely low heart rate (bradycardia),
    • Heart attack
    • Heart valve problems
    • Heart Failure

Due to these conditions, the heart's ability to quickly pump blood while standing is affected.

  • Dehydration: Dehydration can occur due to many conditions such as fever, vomiting, and deficiency of water. Diarrhea and energetic exercise can also cause diarrhea. When orthostatic hypotension occurs due to mild dehydration, symptoms may include:
    • Weakness
    • Dizziness
    • Fatigue
  • Nervous System Disorders: Some nervous system problems can affect the normal blood pressure regulatory system of the body. These nervous disorders include:
    • Parkinson's disease
    • Lewy body dementia
    • Multiple system atrophy
    • Amyloidosis
    • Pure autonomic failure
  • Endocrine Problems: Some thyroid problems such as Addison's disease and hypoglycemia-low blood sugar can cause orthostatic hypotension. These conditions affect the nerves that send signals for the regulation of blood pressure.
  • Eating Meals: Drop in blood pressure after eating meals is a condition known as postprandial hypotension. This condition mostly occurs in older adults.
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Risk Factors of Orthostatic Hypotension

Some factors increase the risk of orthostatic hypotension, such as:

  • Age: Baroreceptors are special types of cells that control blood pressure. These cells are present near the heart and neck. With age, these baroreceptors can no longer regulate blood pressure. Therefore, in older adults above 65 years of age, the risk of orthostatic hypotension is greater as compared to young adults.
  • Medications: Certain medications can increase the risk of orthostatic hypotension, such as:

           Drugs used to treat heart problems and high blood pressure:

  • Diuretics
  • Alpha-blockers/Beta-blockers
  • Angiotensin-converting enzyme inhibitors
  • Nitrates

           Drugs used to treat Parkinson’s disease:

  • Antidepressants
  • Muscle relaxants
  • Narcotics
  • Antipsychotics
  • Certain Medical Conditions: Some diseases can also contribute to the onset of orthostatic hypotension, such as:
  • Heart attack
  • Cardiac arrest
  • Parkinson’s disease
  • Diabetes
  • Heat Exposure: Prolonged stay in a hot environment increases the sweating that results in dehydration. These conditions decrease blood pressure and stimulate orthostatic hypotension.
  • Bed Rest: Long-term bed rest can cause physical weakness and possibly orthostatic hypotension.
  • Pregnancy: During pregnancy possibility of orthostatic hypotension is increased because the circulatory system is expanded.
  • Alcohol: Drinking alcohol can be a possible risk factor for orthostatic hypotension.

Health-Related Complications of Orthostatic Hypotension

Chronic orthostatic hypotension may lead to serious complications, especially in older adults. These may include:

  • Fainting: People with orthostatic hypotension usually faint and fall down. This is the most common complication of orthostatic hypotension.
  • Stroke: Orthostatic hypotension is a condition that causes fluctuation in blood pressure during alternate standing and sitting postures. These fluctuations reduce the blood flow to the brain that can increase the risk of stroke.
  • Cardiovascular Problems: Orthostatic hypotension can increase the risk of cardiovascular problems such as angina or cardiac arrests.

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Prevention

There are several ways to prevent orthostatic hypotension and does not involve the use of medication.

 

  • Take plenty of fluids and keep yourself hydrated. Fluids lost from diarrhea and vomiting should be replaced immediately.
  • Use the required amount of salt in your food. However, ask your doctor before doing that.
  • Sleep with the head of your bed in an elevated position.
  • Use compression socks as they promote circulation and help prevent fluid from pooling in the legs.
  • Avoid all kinds of strenuous activities during hot weather.
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Diagnosis

Orthostatic hypotension is diagnosed by inquiring about medical history and physical examination. Healthcare usually recommends the following tests for diagnosis:

  • Monitoring of Blood Pressure: Orthostatic hypotension is characterized by a 20 mmHg drop in systolic pressure and a 10 mmHg drop in diastolic pressure. For the diagnosis of orthostatic hypotension, the doctor checks the drop in pressure in the standing position within 2-5 minutes.
  • Blood Tests: Blood tests determine the cause of low blood pressure. A decrease in blood sugar or deficiency of red blood cells can cause a drop in blood pressure.
  • Electrocardiogram (ECG or EKG): This is a noninvasive test that determines the abnormalities in heart structure and functioning.  This test is performed to check any heart problems that can cause orthostatic hypotension. In an ECG test, electrodes are attached to the chest, arms, or legs. These electrodes collect the electrical signals produced by the heart and send them to a machine that creates a pattern either on paper or a screen.
  • Echocardiogram: In an echocardiogram exam, sound waves produce a video image of the heart in motion. A transducer is used that directs sound waves to the heart. These waves upon reflection create a video image that helps in the detection of heart problems.
  • Stress Test: It is also known as an exercise stress test, in which the heart's function is monitored during physical activity. Heart problems can be detected during physical activity because during this the heart pumps harder and faster. Otherwise, heart problems can’t be noticed. This test is performed during walking on a treadmill or riding a bike. In a stress test, heart rhythm, blood pressure, and breathing are monitored.
  • Tilt Table Test: A tilt table test is usually recommended if the patient is experiencing frequent fainting. In this test, a patient lies on a table that is tilted to raise the upper body. During tilting, blood pressure is recorded.

Treatment of Orthostatic Hypotension | When to Consult a Doctor

Orthostatic hypotension is treated by restoring low blood pressure. The cause of the disease often determines the treatment approach. In the case of orthostatic hypotension, dehydration, and heart problems are focused on during treatment.

Mild hypotension can be overcome by sitting if feeling lightheaded in a standing position. If this condition is the result of medicines, the healthcare company recommends an alternative drug or medication.

Possible treatments may include:

  • Lifestyle Changes: Orthostatic hypotension is usually treated by simple lifestyle changes, such as:

    • Drinking plenty of water

    • Quitting alcohol

    • Avoiding overheating

    • Avoiding crossing of legs while sitting

    • Standing up slowly

  • Compression Stockings: Pooling of blood in the lower part of the body is prevented by abdominal binders or other compression stockings.

  • Medications: Some medicines are used for orthostatic hypotension, such as:

    • Midodrine 

    • Droxidopa 

    • Fludrocortisone 

    • Mestinon

    • Regonol

If you experience severe symptoms of orthostatic hypotension, consult a neurologist as soon as possible.

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