Orthostatic Hypotension : Causes-Symptoms-Diagnosis-Treatment

What Is Orthostatic Hypotension (Postural Hypotension)?

Orthostatic method: an upright posture. Hypotension is low blood strain. The situation is also referred to as postural hypotension.

Orthostatic hypotension is a drop in blood strain that takes place while moving from a laying down (supine) function to a standing (upright) position. The word "orthostasis" means to arise, so the situation is described as low blood stress (hypotension) that happens upon status.

When standing up, gravity moves blood from the upper body to the decreased limbs. As a result, there may be a brief discount in the quantity of blood in the upper frame for the coronary heart to pump (cardiac output), which decreases blood stress. Normally, the body quickly counteracts the force of gravity and continues solid blood pressure and blood drift. In the majority, this transient drop in blood stress goes unnoticed. However, this temporary orthostatic hypotension can cause lightheadedness that can bring about falls and damage, particularly in older adults.

What Is Orthostatic Hypotension (Postural Hypotension)?
Orthostatic Hypotension

The frame has difficulty attaining stable blood pressure in human beings with orthostatic hypotension, resulting in a prolonged drop in blood strain that occurs inside minutes after transferring from laying right down to status. The huge majority of human beings with orthostatic hypotension do no longer revel in symptoms related to the situation; it may be detected incidentally during recurring medical trying out. When measuring blood pressure, orthostatic hypotension is defined as a lower in blood stress by means of at least 20mmHg systolic or 10mmHg diastolic within 3 mins of status.

When symptoms and symptoms of orthostatic hypotension do occur, they may be usually the end result of a reduction in blood go with the flow (hypoperfusion) to tissues, specially the mind. Affected people may additionally have fatigue, confusion, dizziness, blurred vision, or fainting episodes (syncope). Less regularly, affected individuals can experience muscle pain inside the neck and shoulders (known as "coat hanger pain"), lower returned pain, or weakness. During an episode of orthostatic hypotension, signs and symptoms are frequently improved in severity by way of physical hobby, warm temperatures, consuming massive meals, or status for lengthy periods of time.

In people with orthostatic hypotension, hypoperfusion to other organs contributes to an elevated hazard of existence-threatening health troubles, which include coronary heart assault or heart failure, a coronary heart rhythm abnormality called atrial traumatic inflammation, stroke, or continual kidney failure. Additionally, affected individuals might also get injured from falls for the duration of fainting episodes.

  1. Circulatory system

  1. Heart

  2. Arteries

  3. Veins

  4. Blood vessels

Medical terms

  • Orthostatic hypotension (additionally called postural hypotension) is an unexpected dip in blood strain that occurs whilst you arise once you’ve been sitting or lying down.
  • When you stand, blood obviously rushes in your legs and your blood strain drops. Your frame has to work harder to preserve blood moving back up to the heart via boosting your blood stress and heart fee for a couple of minutes.
  • Orthostatic hypotension — also referred to as postural hypotension — is a form of low blood strain that happens when standing after sitting or mendacity down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting.

Orthostatic hypotension can be slight. Episodes might be short. However, long-lasting orthostatic hypotension can sign more-serious problems. It's essential to peer a health care provider in case you regularly experience lightheadedness when status up.

Occasional orthostatic hypotension is normally caused by something apparent, which includes dehydration or lengthy bed rest. The situation is effortlessly treated. Chronic orthostatic hypotension is usually a sign of some other health trouble, so remedy relies upon the cause.

Anyone can get orthostatic hypotension:

  • Anemia or vitamin B12 deficiency.

  • Dehydration from diarrhea, vomiting or diuretics.

  • Endocrine problems, including diabetes, thyroid disease and Addison’s disease.

  • Heart conditions, including arrhythmias and heart valve disease.

  • Medications for high blood pressure (hypertension), heart disease and depression.

  • Neurological problems, such as Parkinson’s disease and dementia.

  • Pregnancy, especially during the first 24 weeks of pregnancy.

  • Prolonged immobility due to illness, including pregnancy bed rest.

Symptoms Orthostatic hypotension (postural hypotension)

Ever sense lightheaded or woozy while you get away from bed or up from a chair?

Sometimes, it may take a moment (or several) to carry your blood stress back to normal, and you could possibly experience dizzy, confused, queasy, or have blurry imaginations and prescient until your body adjusts and catches up. Some humans may additionally even faint.

The biggest situation is where you may fall and hurt yourself in case you faint. Large swings in blood stress could also cause a stroke if the blood float for your brain is interrupted frequently.

The maximum not unusual symptom of orthostatic hypotension is lightheadedness or dizziness while standing after sitting or lying down. Symptoms usually closing in less than a couple of minutes.

Orthostatic hypotension symptoms and signs encompass:

  • Lightheadedness or dizziness upon standing

  • Blurry vision

  • Weakness

  • Fainting (syncope)

  • Confusion

When to see a doctor

Occasional dizziness or lightheadedness can be minor — caused through slight dehydration, low blood sugar or overheating. Dizziness or lightheadedness can also result from standing after sitting for a long time. If these signs manifest simplest every so often, there's probably no purpose for the problem.

It's important to see a health care issuer for common signs and symptoms of orthostatic hypotension. Losing focus, even for just a few seconds, is severe. It calls for seeing a provider properly.

Keep a document of your signs, once they befell, how lengthy they lasted and what you had been doing on the time. Tell your care issuer if signs and symptoms arise at times that could be dangerous, which include whilst riding.

Causes Orthostatic hypotension (postural hypotension)

Orthostatic hypotension may be a transient issue, or it may be persistent. Many times, the precise cause of this condition isn’t known. Other instances, there are direct causes, consisting of medications and persistent bleeding.

When standing from a sitting or lying role, gravity causes blood to gather within the legs and belly. Blood pressure drops because there is much less blood flowing lower back to the heart.

Usually, unique cells (baroreceptors) near the heart and neck arteries sense this decrease blood strain. The baroreceptors ship indicators to the brain. This tells the heart to beat quicker and pump greater blood, which evens out blood pressure. These cells additionally slim the blood vessels and grow blood strain.

Orthostatic hypotension takes place when something interrupts the frame's manner of coping with the low blood strain. Many conditions can cause orthostatic hypotension, inclusive of:

  • Dehydration. Fever, vomiting, no longer consuming sufficient fluids, severe diarrhea and strenuous workout with a variety of sweating can all cause dehydration. Dehydration decreases blood extent. Mild dehydration can cause signs of orthostatic hypotension, together with weakness, dizziness and fatigue.

  • Heart problems. Some heart situations that could result in low blood pressure consist of extremely low coronary heart charge (bradycardia), coronary heart valve problems, coronary heart assault and heart failure. These conditions save the body from quickly pumping greater blood when status up.

  • Endocrine problems. Thyroid conditions, adrenal insufficiency (Addison's sickness) and low blood sugar (hypoglycemia) can motivate orthostatic hypotension. So can diabetes, that may damage the nerves that help send alerts that control blood stress.

  • Nervous system disorders. Some frightened device problems, together with Parkinson's ailment, a couple of gadget atrophy, Lewy frame dementia, pure autonomic failure and amyloidosis, can disrupt the body's capability to manipulate blood pressure.

  • Eating meals. Some people have low blood pressure after eating food (postprandial hypotension). This circumstance is extra commonplace in older adults.

Risk factors Orthostatic hypotension (postural hypotension)

The risk factors for orthostatic hypotension include:

  • Age. Orthostatic hypotension is not unusual in folks that are age sixty five and older. Special cells (baroreceptors) close to the heart and neck arteries that manage blood stress can slow as you age. It also may be more difficult for an getting older heart to hurry as much as make up for drops in blood stress.

  • Medications. These encompass medicinal drugs used to deal with excessive blood pressure or coronary heart disorder, along with diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and nitrates.
    Other medicinal drugs that can increase the danger of orthostatic hypotension encompass medicinal drugs used to deal with Parkinson's ailment, sure antidepressants, positive antipsychotics, muscle relaxants, medications to treat erectile disorder and narcotics.

  • Certain diseases. Diseases that may increase the risk of low blood pressure consist of a few heart situations, along with heart valve problems, coronary heart assault and coronary heart failure. They additionally encompass certain apprehensive gadget disorders, consisting of Parkinson's disease. And they encompass illnesses that cause nerve damage (neuropathy), along with diabetes.

  • Heat exposure. Being in a warm surroundings can cause heavy sweating and probably dehydration, that may lower blood stress and trigger orthostatic hypotension.

  • Bed rest. Staying in bed for a long time due to an illness or damage can cause weakness. This can result in orthostatic hypotension.

  • Alcohol. Drinking alcohol can increase the risk of orthostatic hypotension.

Complications Orthostatic Hypotension

A common complication of orthostatic hypotension is syncope, which is a temporary loss of cognizance (otherwise known as fainting). Injuries associated with fainting and falling are some other viable trouble, mainly in older adults.

Additionally, residing with blood strain that often drops and rises can increase the hazard of stroke and different cardiovascular conditions.

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

  • Falls. Falling due to fainting is a commonplace hassle in people with orthostatic hypotension.

  • Stroke. The swings in blood strain from status and sitting due to orthostatic hypotension may be a chance element for stroke because of the reduced blood supply to the brain.

  • Cardiovascular diseases. Orthostatic hypotension may be a risk aspect for cardiovascular diseases and complications, along with chest ache, coronary heart failure or coronary heart rhythm problems.

Can you recover from orthostatic hypotension?

Yes you can recover from orthostatic hypotension This is a condition where your blood pressure decreases when you become upright usually after having been lying down or sitting for some time It is also called postural hypotension You can recover from this condition by changing positions slowly For instance if you are in bed get up slowly and sit or stand for five minutes before moving around rapidly This will help to prevent fainting due to sudden change of position.

How do I stop getting dizzy when I stand up?

Sometimes when you stand up you may feel dizzy or light-headed You may even feel like you're going to faint This is called orthostatic hypotension Orthostatic hypotension refers to the sudden drop in blood pressure that occurs with standing up The dizziness you experience is a result of your brain not receiving enough blood and oxygen.

Is orthostatic hypotension life threatening?

Orthostatic hypotension or low blood pressure when standing is commonly caused by aging diabetes dehydration or medications Orthostatic hypotension can be dangerous When a person has orthostatic hypotension their body's ability to pump blood from the lower parts of the body to the brain is impaired The heart must speed up significantly to overcome this impairment The extra stress on the heart may lead to problems for people with heart disease such as irregular heartbeat and heart failure Orthostatic hypotension may also cause headaches and fainting which can result in injury if a person falls down.

Can orthostatic hypotension go away?

Orthostatic hypotension is a drop in blood pressure when you rise from a seated position Blood pressure is the force of your blood pushing against the walls of your arteries When you're horizontal gravity helps blood return to your heart But when you rise gravity becomes less of a factor and blood pools in your legs causing your blood pressure to fall Despite its name orthostatic hypotension isn't always caused by an orthostatic position - that is standing up Orthostatic hypotension can be caused by certain medications or by dehydration If it's caused by medication it will go away once you stop taking those drugs Dehydration caused orthostatic hypotension will also go away.

Prevention Orthostatic Hypotension

If you’re liable to orthostatic hypotension, these steps can reduce signs:

  • Keep your temperature moderate: Don’t take particularly warm baths or showers.

  • Stay hydrated: Drink lots of water, limit alcohol and avoid heavy, high-carbohydrate food.

  • Don’t sleep flat: Elevate your head at night time by using extra pillows or tilting the bed.

  • Prepare before standing: Give yourself greater time to move into a status function after sitting or mendacity down. Have something sturdy nearby to keep onto while you rise up.

  • Move your muscles: March your feet in case you have to stand for prolonged durations. Do isometric sports (squeeze a gentle rubber ball or towel, or clench and unclench your hands) to elevate blood pressure earlier than status.

  • Support blood pressure: Wear compression stockings or a belly binder to improve blood movement and strain.

Diagnosis Orthostatic hypotension (postural hypotension)

If your physician suspects that you have orthostatic hypotension, they'll take a look at your blood pressure even as you’re sitting, mendacity down, and status.

Your health practitioner can diagnose orthostatic hypotension if your systolic blood pressure (the pinnacle number) drops via 20 millimeters of mercury (mm Hg)Trusted Source or your diastolic blood strain (the lowest quantity) drops by 10 mm Hg within 3 mins of standing up.

A health care provider's aim in comparing orthostatic hypotension is to find the reason and determine remedy. The motive is not recognised.

A care provider might overview medical history, medications and signs and symptoms and conduct a physical exam to help diagnose the situation.

A provider additionally might propose one or greater of the following:

  • Blood pressure monitoring. This entails measuring blood stress even as sitting and status. A drop of 20 millimeters of mercury (mm Hg) within the pinnacle range (systolic blood stress) within 2 to five minutes of standing is a sign of orthostatic hypotension. A drop of 10 mm Hg in the bottom wide variety (diastolic blood strain) inside 2 to 5 minutes of standing additionally indicates orthostatic hypotension.

  • Blood tests. These can offer data approximately universal fitness, consisting of low blood sugar (hypoglycemia) or low crimson blood cell degrees (anemia). Both can cause low blood stress

  • Electrocardiogram (ECG or EKG). This quick and painless check measures the electrical hobby of the coronary heart. During an ECG, sensors (electrodes) are connected to the chest and sometimes to the arms or legs. Wires hook up with a system, which prints or displays effects. An ECG can display modifications inside the heart rhythm or coronary heart shape and problems with the delivery of blood and oxygen to the coronary heart muscle.
    An ECG may not stumble on occasional coronary heart rhythm modifications. Your fitness care issuer can also propose monitoring your heartbeat at home. A transportable ECG tool, known as a Holter reveal, can be worn for an afternoon or greater to report the coronary heart's interest at some stage in daily activities.

  • Echocardiogram. Sound waves are used to create pictures of the heart in movement. An echocardiogram can display blood flow through the heart and coronary heart valves. The check can assist identify structural heart disease.

  • Stress test. A pressure take a look at is completed throughout the workout, inclusive of strolling on a treadmill. People who can not workout are probably given medicine to make the coronary heart paintings tougher. The coronary heart is then monitored with electrocardiography, echocardiography or other assessments.

  • Tilt table test. A tilt desk takes a look at how the body reacts to changes in position. It includes lying on a flat table that tilts to raise the top a part of the frame. The changes in role mimic the motion from mendacity right down to status. Blood strain is taken regularly as the desk is tilted.

  • Valsalva maneuver. This noninvasive test determines how nicely the autonomic worried machine is working. It requires inhaling deeply and pushing the air out through the lips, as though looking to blow up a stiff balloon. Heart price and blood strain are checked in the course of the take a look at.

Treatment Orthostatic hypotension (postural hypotension)

The first steps in treatment of orthostatic hypotension are analysis and management of the underlying motive. An affected person with symptomatic orthostatic hypotension who has a disease with no whole or particular therapy may also gain from nonpharmacologic interventions. Increasing salt and fluid consumption frequently is a preliminary step, despite the fact that it can be hard to undertake in a few sufferers, which include those with extreme congestive coronary heart failure. Nonsteroidal anti-inflammatory drugs can be used to increase intravascular volume.

The mineralocorticoid fludrocortisone (Florinef) may be utilized in some sufferers to increase intravascular quantity.Eight,13–15 This agent should be used judiciously; similarly to the hazard of volume overload, many sufferers taking fludrocortisone additionally expand hypokalemia or hypomagnesemia. Additional side outcomes of this remedy consist of headache, edema, weight gain, and supine high blood pressure.

Treatment for orthostatic hypotension is directed at the cause rather than the low blood pressure itself. For example, if dehydration causes orthostatic hypotension, your fitness care issuer may propose way of life adjustments including drinking more water. If a medicinal drug reasons low blood strain when standing, treatment may additionally contain changing the dose or preventing the drug.

For mild orthostatic hypotension, one of the only remedies is to sit or lie and go into reverse right now after feeling lightheaded upon status. Often, signs will disappear. Sometimes, medications have to deal with orthostatic hypotension.


If orthostatic hypotension does not enhance with way of life changes, medicinal drugs can help to grow blood pressure or blood volume. The kind of medicine depends on the kind of orthostatic hypotension.

Drugs that may be used to deal with orthostatic hypotension include midodrine (Orvaten), droxidopa (Northera), fludrocortisone or pyridostigmine (Mestinon, Regonol).

Talk to your fitness care company about the risks and advantages of these pills to determine which one is excellent for you.

Lifestyle and home remedies

Some easy steps can help control or save your orthostatic hypotension. These consist of:

  • Wearing waist-high compression stockings. These may help improve blood flow and reduce the signs and symptoms of orthostatic hypotension. Wear them at some point of the day, however take them off for bed and whilst lying down.

  • Getting plenty of fluids. Keeping hydrated helps save you signs and symptoms of low blood pressure. Drink masses of water earlier than long intervals of standing, or any sports that tend to cause symptoms.

  • Avoiding alcohol. Alcohol can worsen orthostatic hypotension, so restrict or avoid it absolutely.

  • Increasing salt in the diet. This has to be finished cautiously and only after discussing it with a health care issuer. Too much salt can cause blood stress to grow past a healthful level, creating new health risks.

  • Eating small meals. If blood pressure drops after eating, having small, low-carbohydrate food might help.

  • Exercising. Regular cardiovascular and strengthening physical activities would possibly help lessen symptoms of orthostatic hypotension. Avoid workout in very hot, humid climates.

  • Moving and stretching in certain ways. Stretch and flex calf muscle groups earlier than sitting up. For signs and symptoms, squeeze thighs together and squeeze stomach and buttock muscular tissues. Squat, march in location or rise onto tiptoes.

  • Getting up slowly. Move slowly from a lying to standing function. Also, whilst getting off the bed, sit down on the brink of the bed for a minute before standing.

  • Raising the head of the bed. Sleeping with the pinnacle of the bed barely raised can help combat the consequences of gravity.

Preparing for your appointment

You do not want to do something special before having your blood pressure checked. But it's helpful to wear a brief-sleeved blouse or a unfastened long-sleeved shirt that can be pushed up for the duration of the take a look at. Doing so facilitates fitting the blood pressure cuff around the arm well.

Take your blood pressure frequently at home, and hold a log of your readings. Bring the log with you in your health care provider's appointment.

Take your blood pressure first issue within the morning. Lie down for the primary reading. Complete taking your blood stress, then wait one minute. Stand and take the second reading.

Also take your blood pressure at those times:

  • After you eat

  • When your symptoms are least severe

  • When your symptoms are most severe

  • When you take your blood pressure medications

  • One hour after you take your blood pressure medications

Here's a few data to help you get prepared for your appointment.

What you can do

When you make the appointment, ask if there may be something you need to do earlier, such as limit your weight-reduction plan for a blood check. Plan to carry a member of the family or friend in your appointment, if feasible, to help you consider all of the information you are given.

Make a listing of the following:

  • Your symptoms, Consisting of any that could appear unrelated to low blood pressure, what triggers them and after they commence.

  • Key personal information, Inclusive of a family record of low blood pressure and major stresses or latest life adjustments.

  • All medications, vitamins or supplements You take, which includes doses. Or carry within the bottles of all of the medicinal drugs you are taking.
    Some medications — along with cold medicines, antidepressants, beginning manipulate drugs and others — can affect your blood stress. Don't stop taking any prescription medicines that you suppose might affect your blood stress without your card issuer's recommendation.

  • Questions to ask your care provider.
    Be prepared to discuss your diet and exercising behavior, specifically the amount of salt on your food regimen. If you do not already observe a weight loss plan or workout routine, be equipped to talk to your company about challenges you may face in getting commenced.

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

  • What's the most likely cause of my symptoms?

  • Could my medications be a factor?

  • What are other possible causes for my symptoms or condition?

  • What tests will I need?

  • What's the most appropriate treatment?

  • How often should I be screened for low blood pressure? Should I measure it at home?

  • I have other health conditions. How can I best manage these conditions together?

  • Do I need to follow any diet or activity restrictions?

  • Are there any brochures available? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider will likely ask you questions, such as:

  • How often do you have symptoms?

  • How severe are your symptoms?

  • What, if anything, seems to improve your symptoms?

  • What, if anything, appears to worsen your symptoms?

  • Do you ever temporarily stop taking your medications because of side effects or because of the expense?

General summary

  1. The most common cause of orthostatic hypotension is dehydration followed by a deficiency of B12 diabetes thyroid disease and medications such as antihypertensive drugs Orthostatic hypotension can be a side effect of some medications including diuretics beta-blockers antihistamines and sedatives.
  2. Postural hypotension is a sudden drop in blood pressure that occurs when a person stands up. It often causes dizziness, weakness, fainting and in severe cases can lead to complete loss of consciousness. While postural hypotension is usually harmless it is important to understand the causes and how it can be managed.

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