Orthostatic hypotension

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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.

See Also

• Hypotension
• Syncope
• Autonomic nervous system
• Dehydration

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