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Orthostatic Hypotension
(Postural Hypotension)

Definition:
Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure dramatically decreases (more than 20/10 mm Hg) when rising from a lying down or sitting position to a standing position.

Causes:
Orthostatic hypotension has several causes.
  • Hypovolemia is the most common cause. It may be due to:
    • Excessive use of loop diuretic medications (furosemide, bumetanide, ethacrynic acid)
    • Vasodilator medications (nitrate preparations, Ca blockers, or ACE inhibitors)
    • Dehydration
    • Prolonged bed rest
    • Addison’s disease (with inadequate salt intake)
  • Impaired autonomic (nerve) reflex due to certain diseases:
    • Diabetes
    • Pernicious anemia
    • Amyloidosis
    • Guillain-Barre syndrome
    • Riley-Day syndrome
    • Shy-Drager syndrome
  • Decreased heart muscle contractility or vascular responsiveness
  • Certain drugs:
    • Monoamine oxidase inhibitors (MAO inhibitors) (isocarboxazid, phenelzine, tranylcypromine)
    • Tricyclic antidepressants (nortriptyline, amitriptyline, desipramine, imipramine, protriptyline)
    • Tetracyclic antidepressants
  • Phenothiazine antipsychotic drugs (chlorpromazine, promazine, thioridazine)
  • Quinidine
  • Levodopa
  • Barbiturates
  • Alcohol
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Increased age
  • Use of certain drugs:
    • Loop diuretics
    • Vasodilators
    • MAO inhibitors
    • Tricyclic antidepressants
    • Tetracyclic antidepressants
    • Phenothiazine antipsychotic drugs
    • Quinidine
    • Levodopa
    • Barbiturates
    • Alcohol
  • Inadequate fluid intake
  • Prolonged bed rest
  • Certain diseases or conditions:
    • Atherosclerosis
    • Advanced heart failure
    • Addison’s disease
    • Diabetes
    • Pernicious anemia
    • Amyloidosis
    • Guillain-Barre syndrome
    • Riley-Day syndrome
    • Shy-Drager syndrome
Symptoms:
Symptoms include:
  • Mild to moderate reduction in brain blood flow:
    • Faintness
    • Light-headedness
    • Dizziness
    • Weakness
    • Confusion
    • Visual Blurring
  • Severe reduction in brain blood flow:
    • Fainting or brief loss of consciousness (syncope)
    • Generalized seizures

Exercise or having eaten a heavy meal may worsen symptoms.

If you experience any of these symptoms do not assume it is due to orthostatic hypotension. These symptoms may be caused by other health conditions. If you experience any one of them, see your doctor.

Diagnosis:
Orthostatic hypotension is diagnosed when symptoms are present and there is a measured reduction in blood pressure while standing, which is relieved by lying down. The underlying cause must be determined on an individual basis.

Treatment:
Treatment for orthostatic hypotension depends on the cause.

Treatments include:

Adjusting Dosage or Type of Medication
When orthostatic hypotension is due to hypovolemia related to medications, an adjustment in the dosage or discontinuing the medication may be needed to reverse the condition.

Treating Dehydration
Orthostatic hypotension resulting from dehydration is treated with fluids and electrolyte (mainly sodium) replacement.

Minimizing Bed Rest
If bed rest is the cause of orthostatic hypotension, symptoms of orthostatic hypotension may be improved by increasing time spent sitting up in bed.

Medications
A number of medications may be given to boost blood pressure, including:
  • Fludrocortisone
  • Pindolol
  • Dihydroergotamine
  • Ibuprofen
  • Clonidine
Other Interventions
In some cases, individuals may be encouraged to increase their intake of salt. Fitted elastic stockings that go up to the waist may be worn. Individuals may need to be taught to rise from lying down, to sit up, and to stand in a slow and gradual fashion. Similarly, they should be discouraged from standing still for too long a time.

Prevention:
There is no way to prevent orthostatic hypotension if it is a result of other diseases or conditions. However, if your orthostatic hypotension relates to medications, dehydration, or bed rest, you should talk with your healthcare provider about adjusting your medications, drinking adequate fluids, and minimizing bed rest, respectively.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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