(Postural Hypotension)
Definition
Definition
Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.
Measuring of Blood PressureCopyright © Nucleus Medical Media, Inc.
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Causes
Causes
As you stand, blood falls toward your lower body in response to gravity. To help keep blood in the upper body:
- Blood vessels in the lower body will tighten to help push blood back up.
- The muscles in the lower body contract, or squeeze, to help push blood to upper body.
- The heart will contract a little harder to pump blood up toward the brain.
Blood pressure is also affected by the amount of blood in the blood vessels. Low levels of blood will decrease the blood pressure and make it harder for the body to compensate when you stand. Low blood volume called, hypovolemia, is the most common cause of orthostatic hypotension. It may be due to:
- Excessive use of loop diuretic medications
- Vasodilator medications, such as nitrate preparations, calcium channel blockers, or ACE inhibitors
- Dehydration
- Prolonged bedrest
- Addison’s disease with inadequate salt intake
Orthostatic hypotension will occur when one or more of these factors does not work as expected. It may be associated with:
- Diseases or conditions that impair nervous system or nerves that controls the widening or shrinking of blood vessels
- Decreased ability of the heart to contract or reaction of blood vessels
- Medications that can affect nervous system or cardiovascular system
- Alcohol—can slow the reaction of the nervous system
Risk Factors
Risk Factors
Factors that increase your chance of orthostatic hypotension include:
- Increased age
-
Use of certain drugs such as:
- Loop diuretics
- Vasodilators
- MAO inhibitors
- Tricyclic antidepressants
- Tetracyclic antidepressants
- Phenothiazine antipsychotic drugs
- Quinidine
- Levodopa
- Barbiturates
- Alcohol
- Inadequate fluid intake
- Prolonged bedrest
-
Certain diseases or conditions:
- Atherosclerosis
- Advanced heart failure
- Addison’s disease
- Diabetes
- Pernicious anemia
- Amyloidosis
- Guillain-Barre syndrome
- Riley-Day syndrome
- Multiple system atrophy
Symptoms
Symptoms
Orthostatic hypotension may cause:
-
Mild to moderate reduction in brain blood flow:
- Faintness
- Lightheadedness
- Weakness
- Confusion
- Visual blurring
-
Severe reduction in brain blood flow:
- Fainting (syncope) or brief loss of consciousness
Exercise or having eaten a heavy meal may worsen symptoms.
Diagnosis
Diagnosis
Orthostatic hypotension is diagnosed when symptoms are present and there is a measured reduction in blood pressure while standing, which is relieved by lying down.
Treatment
Treatment
When possible treatment will focus on resolving the orthostatic hypotension completely. If a complete resolution is not possible, treatment will focus on managing symptoms.
Resolving Symptoms
Treatment will depend on the cause. Examples include:
- Adjusting or stopping medications that cause problems.
- Avoiding prolonged bed rest. Make sure to sit up each day. Start slowly and increase the time and frequency.
- Preventing dehydration by increasing fluid and electrolyte intake.
Managing Symptoms
Common approaches include:
The doctor may recommend prescription medications to increase blood pressure.
Dietary changes may also help increase blood pressure or prevent very low blood pressure. A dietitian may help create a diet plan. Steps may include:
- Increasing salt intake.
- Eating smaller, more frequent meals with fewer carbohydrates. May help to avoid low blood pressure after eating.
- Limiting or eliminating alcohol.
Behavioral changes that may help include:
- Using fitted elastic stockings that go up to the waist.
- Learning to slowly move from a lying or sitting position to a sitting or standing position.
- Avoiding sitting or standing still for prolonged periods of time.
Prevention
Prevention
There is no way to prevent orthostatic hypotension if it is a result of other diseases or conditions. However, if your orthostatic hypotension relates to medications, dehydration, or bedrest, you should talk with your healthcare provider about treatment options.
RESOURCES:
National Organization for Rare Disorders http://www.rarediseases.org/
CANADIAN RESOURCES:
References:
Ferri FF. Ferri’s Clinical Advisor: Instant Diagnosis and Treatment. 8th ed. St. Louis, MO: Mosby; 2006.
Goldman L. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: Saunders; 2004.
Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: Diagnosis and treatment. Am J Med. 2007;120:841-847.
Lenders JW, Eisenhofer G, et al. Phaeochromocytoma. Lancet. 2005;366:665-675.
NINDS orthostatic hypotension information page. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/orthostatic_hypotension/orthostatic_hypotension.htm
Updated September 30, 2011. Accessed August 21, 2014.
Orthostatic syncope. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated July 25, 2014. Accessed August 21, 2014.
Shibao C, Grijalva CG, et al. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120:975-980.
3/24/2015 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills PB, Fung CK, et al. Nonpharmacologic management of orthostatic hypotension: A systematic review. Arch Phys Med Rehab. 2015;96(20):366-375.
Last Updated: 3/24/2015