About Orthostatic Hypotension (Postural Hypotension)
The causes of orthostatic hypotension are usually related to problems with the autonomic nervous system. The autonomic nervous system controls involuntary processes like heart rate, blood pressure, breathing, and digestion. When this system is disrupted, the body may not be able to control blood pressure appropriately. Other medical conditions can also contribute to orthostatic hypotension.
The non-modifiable risk factors for orthostatic hypotension are factors that cannot be changed. These include:
- Aging: The condition is more common in older adults.
- Certain medical conditions: Disorders that affect the autonomic nervous system can increase the risk.
The modifiable risk factors for orthostatic hypotension are factors that can be influenced or changed. These include:
- Medications: Certain drugs can affect the normal reflexes that regulate blood pressure.
- Dehydration: Not drinking enough fluids can contribute to orthostatic hypotension.
- Alcohol intake: Drinking alcohol can lower blood pressure.
- Underlying conditions: Conditions like Parkinson's disease and diabetes can cause dysfunction of the autonomic nervous system and increase the risk of orthostatic hypotension.
It's important to note that these risk factors may vary from person to person. It's best to consult with your healthcare professional for personalized advice and management.
The most common symptoms of orthostatic hypotension include:
- Dizziness or light headedness
- Fatigue
- Headache
- Weakness
- Nausea
As orthostatic hypotension progresses or becomes more severe, other common symptoms may occur, such as:
- Blurred vision
- Confusion
- Leg buckling
- Chest pain
- Neck and shoulder pain
- Fainting
It's important to note that these symptoms can vary from person to person. If you experience any of these symptoms regularly, it is advisable to seek medical advice. Complications of orthostatic hypotension can include falling and serious injuries, as well as masking more serious underlying conditions like cardiovascular diseases and strokes.
To diagnose orthostatic hypotension, the following examinations, tests, and procedures are commonly performed:
- Physical exam: The healthcare provider will look for physical signs of other medical problems that may have symptoms like orthostatic hypotension. The healthcare professional will also take blood pressure measurements.
- Medical history: Gathering information about your medical history and any previous diagnoses is crucial in understanding your condition.
- Lab tests: Specific lab tests may be recommended, such as a blood draw, to check for abnormalities in blood chemistry and hormone levels.
- Imaging studies: Depending on the symptoms, imaging studies like X-rays or magnetic resonance imaging (MRI) scans may be ordered to identify any structural abnormalities or underlying causes.
- Clinical procedures: These may include evaluations of specific body systems to gather more information for diagnosis.
To determine the stage or severity of orthostatic hypotension, additional examinations, tests, and procedures may be conducted:
- Orthostatic blood pressure measurement: This test involves measuring blood pressure while lying down, sitting up, and standing to assess changes in blood pressure with position changes.
- Tilt table test: This test evaluates how your blood pressure and heart rate respond to changes in posture on a specially designed table.
- Autonomic function tests: These tests assess the functioning of the autonomic nervous system, which controls involuntary bodily functions like blood pressure regulation.
- Cardiac evaluation: A thorough evaluation of your heart function may be done to rule out any cardiac causes contributing to orthostatic hypotension.
It's important to consult with your healthcare provider who can recommend specific examinations, tests, and procedures based on your individual situation.
The goals of treatment for orthostatic hypotension are to reduce the risk of falls and fall-related injuries, to prolong safe standing time, and to improve physical capabilities, mobility, and independent functioning. To achieve these treatment goals, various approaches can be taken:
Medications:
- Vasopressors: These aim to increase blood pressure and improve symptoms of orthostatic hypotension. However, they should be used with caution as they may cause or worsen supine hypertension (high blood pressure when lying down).
- Changing or discontinuing medications that may be causing orthostatic hypotension.
Health Behavior Changes:
- Increasing fluid intake to prevent dehydration, which can make orthostatic hypotension worse.
- Adjusting diet to include more salt, which can help raise blood pressure.
Other treatments:
- Non-pharmacologic interventions, such as physical therapy exercises and postural training, can improve symptoms and functional abilities.
- Treating the underlying condition that is causing orthostatic hypotension, such as Parkinson's disease or diabetes.
- Wearing compression stockings to reduce symptoms.
It's important to note that treatment should be individualized based on the underlying cause and the patient's specific needs. Consult with a healthcare professional for personalized advice. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.