Overview
Orthostatic hypotension, also known as postural hypotension, is a condition where an individual experiences a drop in blood pressure upon standing, causing symptoms such as dizziness, lightheadedness, or fainting. It occurs when the body's normal mechanism for adjusting blood pressure in response to changes in body position is disrupted. The condition can be mild and short-lived, or it can be chronic and signal more serious underlying health issues. Treatment depends on the underlying cause, which can range from dehydration to more serious medical conditions. If you frequently experience symptoms of orthostatic hypotension, it is important to consult a healthcare provider.
Understanding the disease
Symptoms
The symptoms of orthostatic hypotension (postural hypotension) include lightheadedness or dizziness when standing after sitting or lying down, which usually lasts less than a few minutes. Other symptoms may include blurred vision, fatigue, headache, and, in severe cases, fainting. If you frequently experience these symptoms, it is important to consult a healthcare provider.
Risk Factors
The risk factors for developing orthostatic hypotension include:
- Age: Orthostatic hypotension is more common in people aged 65 and older due to the natural decline in baroreceptor function and the aging heart's reduced ability to respond to changes in blood pressure.
- Bed rest: Prolonged bed rest can lead to muscle weakness and orthostatic hypotension.
- Heat exposure: Being in a hot environment can cause heavy sweating and dehydration, which can lower blood pressure and trigger orthostatic hypotension.
- Alcohol consumption: Drinking alcohol can increase the risk of orthostatic hypotension.
- Certain medications: Medications used to treat high blood pressure, heart disease, Parkinson's disease, certain antidepressants, antipsychotics, muscle relaxants, erectile dysfunction, and narcotics can increase the risk of orthostatic hypotension.
- Nervous system disorders: Conditions such as Parkinson's disease, multiple system atrophy, Lewy body dementia, pure autonomic failure, and amyloidosis can disrupt the body's ability to control blood pressure.
- Eating meals: Some individuals, particularly older adults, may experience low blood pressure after meals (postprandial hypotension).
- Other diseases: Certain heart conditions, nervous system disorders, and diseases that cause nerve damage (neuropathy), such as diabetes, can increase the risk of low blood pressure and orthostatic hypotension. Remember that orthostatic hypotension can cause serious complications, especially in older adults, including falls, stroke, and cardiovascular diseases. If you suspect you or someone you know is experiencing orthostatic hypotension, consult a healthcare professional for appropriate evaluation and management.
Development
Orthostatic hypotension can develop due to several factors, including:
- Heat exposure: Being in a hot environment can cause heavy sweating and dehydration, leading to a decrease in blood pressure.
- Bed rest: Staying in bed for an extended period due to illness or injury can result in muscle weakness, which may contribute to orthostatic hypotension.
- Alcohol consumption: Drinking alcohol can increase the risk of orthostatic hypotension.
- Medications: Certain medications used to treat high blood pressure, heart disease, Parkinson's disease, depression, and other conditions can lower blood pressure and increase the risk of orthostatic hypotension.
- Nervous system disorders: Disorders that affect the nervous system, such as Parkinson's disease, multiple system atrophy, Lewy body dementia, pure autonomic failure, and amyloidosis, can disrupt the body's ability to control blood pressure.
- Eating meals: In some individuals, especially older adults, consuming meals can cause a drop in blood pressure following meals, known as postprandial hypotension.
- Cardiovascular diseases: Orthostatic hypotension can be a risk factor for cardiovascular diseases, including chest pain, heart failure, and heart rhythm problems. It's important to note that the specific cause of orthostatic hypotension may vary from person to person, and the condition can be influenced by multiple factors.
Assessment and Diagnosis
Triage
You should see a healthcare provider for frequent symptoms of orthostatic hypotension. Losing consciousness, even for just a few seconds, is serious and requires seeing a provider right away. Keep a record of your symptoms and inform your care provider if symptoms occur at times that could be dangerous, such as while driving.
Diagnosis
To diagnose orthostatic hypotension, a healthcare provider typically reviews the patient's medical history, medications, and symptoms. They may conduct a physical exam and recommend blood pressure monitoring while sitting and standing. A drop of 20 mm Hg in the top number (systolic blood pressure) within 2 to 5 minutes of standing is a sign of orthostatic hypotension. If the cause isn't known, additional tests like blood pressure monitoring, tilt table test, or stress test may be recommended.
Management and Treatment
Complications
Complications of orthostatic hypotension can include:
- Falls: Falling as a result of fainting is a common complication in people with orthostatic hypotension.
- Stroke: The swings in blood pressure from standing and sitting can be a risk factor for stroke due to reduced blood supply to the brain.
- Cardiovascular diseases: Orthostatic hypotension can be a risk factor for cardiovascular diseases and complications like chest pain, heart failure, or heart rhythm problems.
Home Remedies
Home remedies for orthostatic hypotension may include the following:
- Gradual Rising: Slowly stand up from a seated or lying down position, allowing your body time to adjust to the change in blood pressure.
- Stay Hydrated: Drink plenty of fluids, especially water, to prevent dehydration, which can contribute to orthostatic hypotension.
- Elevate Your Legs: When sitting or lying down, try propping your legs up on a pillow to help increase blood flow back to the heart.
- Compress Tight Clothing: Loosen any tight clothing that may restrict blood flow.
- Eat Small, Frequent Meals: Consuming small, frequent meals throughout the day can help maintain blood sugar levels and prevent low blood pressure caused by hypoglycemia.
- Avoid Alcohol: Limit alcohol consumption, as alcohol can exacerbate orthostatic hypotension.
- Wear Compression Stockings: If you have a condition that contributes to orthostatic hypotension, wearing compression stockings may help improve blood circulation. It's important to note that these home remedies should be used in conjunction with medical treatment and not as a substitute. If you frequently experience symptoms of orthostatic hypotension, it's essential to consult a healthcare provider to determine the underlying cause and receive proper treatment.
Treatment
Treatment for orthostatic hypotension typically involves addressing the underlying cause. If dehydration is causing orthostatic hypotension, lifestyle changes, such as drinking more water, may be recommended. If a medication is causing low blood pressure when standing, the health care provider may suggest adjusting the dose or switching to a different medication. For mild orthostatic hypotension, one of the simplest treatments is to sit or lie down immediately after feeling lightheaded upon standing. Often, symptoms will disappear. In some cases, medications may be needed to treat orthostatic hypotension. These may include midodrine (Orvaten), droxidopa (Northera), fludrocortisone or pyridostigmine (Mestinon, Regonol). Self-care measures can also help manage or prevent orthostatic hypotension. These include wearing waist-high compression stockings, staying hydrated, avoiding alcohol, and eating small meals. Regular cardiovascular and strengthening exercises may also help reduce symptoms, but it's important to avoid exercising in very hot, humid weather. It's important to consult with a health care provider to determine the best course of treatment based on the individual's specific situation and health condition.