Orthostatic hypotension (postural hypotension)

Description

Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that occurs when standing up after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness, and possibly fainting.

Orthostatic hypotension may be mild. The episodes may be brief. However, the long-lasting orthostatic hypotension can signal more serious problems. It is important to see a health care provider if you frequently dizziness when standing up.

Occasional orthostatic hypotension is usually caused by something obvious, such as dehydration, or prolonged bed rest. The condition is easy to treat. Chronic orthostatic hypotension is usually a sign of another health problem, so that the treatment depends on the cause.

Symptoms

The most common symptom of orthostatic hypotension is lightheadedness or dizziness upon standing after sitting or lying down. The symptoms usually last less than a couple of minutes.

Orthostatic hypotension signs and symptoms include:

  • Dizziness or lightheadedness upon standing
  • Blurred vision
  • Weakness
  • Fainting (syncope)
  • The confusion

When to see a doctor

Dizziness or lightheadedness may be lower — caused by mild dehydration, low blood sugar or overheating. Dizziness or lightheadedness may also be the result of a standing position after sitting for a long time. If these symptoms occur only once in a while, it's likely no cause for concern.

It is important to see a health care provider for the most frequent symptoms of orthostatic hypotension. The loss of consciousness, even for just a few seconds, it is serious. Is required to see a doctor immediately.

Keep a record of your symptoms, when they occurred, how long they lasted and what they were doing at the time. Tell your health care provider if symptoms are present at the time that could be dangerous, such as while driving.

Causes

When standing up from a sitting or lying position, gravity causes the blood to pool in the legs and the belly. Blood pressure drops because there is less blood flowing back to the heart.

Normally, the special cells (baroreceptors) near the heart and of the arteries of the neck make sense to lower the blood pressure. The baroreceptors send signals to the brain. This indicates that the heart beat faster and pump more blood, which levels out your blood pressure. These cells also narrow the blood vessels and increase blood pressure.

Orthostatic hypotension occurs when something disrupts the body's process of dealing with low blood pressure. Many conditions can cause orthostatic hypotension, including:

  • The dehydration. Fever, vomiting, not drinking enough fluids severe diarrhea and vigorous exercise with a lot of sweating can lead to dehydration. Dehydration decreases blood volume. Mild dehydration can cause symptoms of orthostatic hypotension, such as weakness, dizziness and fatigue.
  • The problems of the heart. Some diseases of the heart, which can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure. These conditions prevent the body quickly begins to pump more blood when you're standing.
  • Endocrine problems. Thyroid conditions, adrenal insufficiency (Addison's disease), and low blood sugar (hypoglycemia) can cause orthostatic hypotension. So can diabetes, which can cause damage to the nerves that help send signals to control the blood pressure.
  • Disorders of the nervous system. Some nervous system disorders, such as Parkinson's disease, multiple system atrophy, dementia Lewy bodies, pure autonomic failure and amyloidosis, can alter the ability of the body to control the blood pressure.
  • Meals. Some people have low blood pressure after meals (hypotension postprandial). This condition is more common in older adults.

Risk factors

The risk factors for orthostatic hypotension include:

  • Age. Orthostatic hypotension is common in those who are 65 years of age and older. Special cells (baroreceptors) near the heart and of the arteries of the neck that control the blood pressure can delay the age. It can also be more difficult for an aging heart to speed up to compensate for the fall in blood pressure.
  • Drugs.These include medicines used to treat high blood pressure or heart disease, such as diuretics, alpha-blockers, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors (acei) and nitrates. Other medicines that may increase the risk of orthostatic hypotension include medications used to treat Parkinson's disease, certain antidepressants, some antipsychotics, muscle relaxants, drugs to treat erectile dysfunction and narcotics.
  • Certain diseases. Diseases that may increase the risk of low blood pressure include some diseases of the heart, such as heart valve problems, heart attack and heart failure. Also included are some disorders of the nervous system, such as Parkinson's disease. And which are diseases that cause damage to the nerves (neuropathy), such as diabetes.
  • Exposure to heat. Being in a hot environment can cause excessive sweating and, possibly, the dehydration, which can reduce the blood pressure and cause orthostatic hypotension.
  • The bed rest. Stay in bed for a long time due to an illness or injury can cause weakness. This can lead to orthostatic hypotension.
  • The consumption of Alcohol. Drinking alcohol may increase the risk of orthostatic hypotension.

Drugs. These include medicines used to treat high blood pressure or heart disease, such as diuretics, alpha-blockers, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors (acei) and nitrates.

Other medicines that may increase the risk of orthostatic hypotension include medications used to treat Parkinson's disease, certain antidepressants, some antipsychotics, muscle relaxants, drugs to treat erectile dysfunction and narcotics.

Complications

Persistent orthostatic hypotension can cause serious complications, especially in older adults. These include:

  • Falls. Falling as a result of fainting is a common complication in people with orthostatic hypotension.
  • Stroke. The changes in blood pressure from standing or sitting, as a result of orthostatic hypotension may be a risk factor for stroke due to the reduction of the blood supply to the brain.
  • Cardiovascular diseases. Orthostatic hypotension may be a risk factor for cardiovascular diseases and complications, such as chest pain, heart failure or heart rhythm problems.

Orthostatic hypotension (postural hypotension)

Diagnosis

A health care provider's goal in evaluating orthostatic hypotension is to find the cause and determine the treatment. The cause is not always known.

A care provider can review medical history, medications and symptoms and conduct a physical examination to help diagnose the condition.

A medical professional may also recommend one or more of the following:

  • Blood pressure monitoring. This involves the measurement of the blood pressure while sitting and standing. A fall of 20 millimeters of mercury (mm Hg) in the top number (systolic blood pressure) within 2 to 5 minutes of standing is a sign of orthostatic hypotension. A drop of 10 mm Hg for the bottom number (diastolic blood pressure) in a period of 2 to 5 minutes of a foot, also indicates orthostatic hypotension.
  • Blood tests. These can provide information about health in general, including low blood sugar (hypoglycemia), or low levels of red blood cells (anemia). Both can cause low blood pressure
  • Electrocardiogram (ECG or EKG).This quick and painless test that measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and, at times, the arms or the legs. The cables are connected to a machine that prints or displays the results. Ancan show changes in heart rhythm, or the structure of the heart and problems with the supply of blood and oxygen to the heart muscle. Anmay not detect occasional changes in heart rhythm. Your health care provider may recommend monitoring your heartbeat in your home. A portabledevice, called a Holter monitor, it can be used for a day or more, to record the heart's activity during daily activities.
  • The echocardiogram. Use sound waves to create images of the heart in motion. An echocardiogram can show the flow of blood through the heart and heart valves. The test can help identify structural heart disease.
  • Stress test. A stress test is performed during the exercise, such as walking on a treadmill. People who can not exercise, you may be given a medicine to make the heart work harder. The heart was monitored with electrocardiography, echocardiography or other tests.
  • Tilt table test. A tilt table test shows how the body reacts to the changes in the position. It involves lying on a flat table that tilts to lift the upper part of the body. The changes in the position of mimic the movement from the lying down position to standing. The blood pressure is frequently taken as the table is tilted.
  • The Valsalva manoeuvre. This non-invasive test, is determined by the autonomic nervous system is working. It requires a deep breath and push the air out through the lips, as if trying to fly stiffness in the globe. The heart rate and blood pressure are checked during the test.

Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and, at times, the arms or the legs. The cables are connected to a machine that prints or displays the results. One can show changes in the heart rhythm, or the structure of the heart and problems with the supply of blood and oxygen to the heart muscle.

A can't detect occasional changes in heart rhythm. Your health care provider may recommend monitoring your heartbeat in your home. A portable device called a Holter monitor, it can be used for a day or more, to record the heart's activity during daily activities.

Treatment

The treatment for orthostatic hypotension is directed at the cause rather than the low blood pressure itself. For example, if the dehydration causes orthostatic hypotension, your doctor may suggest lifestyle changes such as drinking more water. If a drug cause low blood pressure when standing up, the treatment may involve changing the dose or stopping the drug.

For a mild orthostatic hypotension, one of the simplest treatments is to sit or lie down immediately after the feeling of dizziness when standing up. Often, the symptoms will disappear. Sometimes, medications are necessary for the treatment of orthostatic hypotension.

Drugs

If orthostatic hypotension does not improve with lifestyle changes, medications may be needed to increase the blood pressure or the volume of the blood. The type of medication depends on the type of orthostatic hypotension.

Medications that can be used to treat orthostatic hypotension include midodrine (Orvaten), droxidopa (Northera), fludrocortisone or pyridostigmine (Mestinon, Regonol).

Talk with your health care provider about the risks and benefits of these medications to determine which one is best for you.

Self-care

Some simple steps can help to control or prevent orthostatic hypotension. These include:

  • Carried in the waist-high compression stockings. These can help to improve blood flow and reduce symptoms of orthostatic hypotension. Wear them during the day, but the take off of the bed and when you lie down.
  • Get plenty of fluids. Keeping hydrated helps to prevent symptoms of low blood pressure. Drink plenty of water before long periods of standing, or in any activity that tend to trigger symptoms.
  • Avoid the consumption of alcohol. The Alcohol can worsen orthostatic hypotension, to limit or completely avoid.
  • The increase of salt in the diet. This must be done carefully and only after discussing with your health care provider. Too much salt can cause your blood pressure to increase beyond a healthy level, the creation of new health risks.
  • Eat small meals. If the low blood pressure after eating, having small, low carb meals can help.
  • Exercise. Regular cardiovascular and strengthening exercises can help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid.
  • Moving and stretching in certain ways. Stretch and flex the muscles of the calf before sitting down. For the symptoms, squeeze the thighs together and tighten your stomach and buttock muscles. Squatting, march in place or location on your toes.
  • Getting up slowly. Move slowly from a lying to a standing position. Also, getting up from the bed, sitting on the edge of the bed for a minute before standing up.
  • Elevate the head of the bed. Sleeping with the head of the bed slightly elevated can help fight the effects of gravity.

Preparing for your appointment

You do not need to do anything special before having your blood pressure. However, it is helpful to use a short sleeve shirt or a loose-fitting, long-sleeved shirt that can be pushed upward during the test. By doing this, you help with the assembly of the blood pressure cuff around the arm correctly.

Take your blood pressure regularly at home, and keep a record of your readings. Bring the log to your health care provider of the appointment.

Take your blood pressure first thing in the morning. Lie on the first reading. Complete taking the blood pressure, then wait a minute. Stand up and take the second reading.

Also take your blood pressure at these times:

  • After eating
  • When the symptoms are less severe
  • When the symptoms are more severe
  • When you take your blood pressure medicines
  • An hour after taking their blood pressure medications

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet for a blood test. Plan to bring a family member or friend to your appointment, if possible, to help you to remember all information that is given to you.

Make a list of the following:

  • Your symptoms, including any that may seem unrelated to the low blood pressure, what triggers and when they began.
  • Key personal information, including family history of low blood pressure and major stresses or recent life changes.
  • All the medications,vitamins, or supplementsyou taking, including dosage. Or bring the bottles of all the medicines that you take. Some medications, such as cold medications, antidepressants, birth control pills and others — can affect your blood pressure. Do not stop taking any prescription medication that you think could affect your blood pressure without the need of your medical care.
  • Questions to askyour care provider. Be prepared to discuss your diet and exercise habits, especially the amount of salt in your diet. If you do not already follow a diet or workout routine, be ready to talk with your provider about the challenges that you might face in the introduction.

All medications, vitamins or supplements that you take, including over-dose. Or bring the bottles of all the medicines that you take.

Some medications, such as cold medications, antidepressants, birth control pills and others — can affect your blood pressure. Do not stop taking any prescription medication that you think could affect your blood pressure without the need of your medical care.

Questions to ask your care provider.

Be prepared to discuss your diet and exercise habits, especially the amount of salt in your diet. If you do not already follow a diet or workout routine, be ready to talk with your provider about the challenges that you might face in the introduction.

For orthostatic hypotension, questions to ask your health care provider include:

  • What is the most likely cause of my symptoms?
  • Could my medication be a factor?
  • What are other possible causes for my symptoms or condition?
  • What tests are needed?
  • What is the most appropriate treatment?
  • How often should I be screened for the low blood pressure? Should I measure it at home?
  • I have other health conditions. How can I best manage these conditions?
  • I need to follow any diet or activity restrictions?
  • There are brochures available? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor will probably ask you questions, such as:

  • How often do you have symptoms?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Did you ever stop taking their medications because of the side effects or the expense?
Symptoms and treatment of Orthostatic hypotension (postural hypotension)