Orthostatic hypotension: Symptoms, Causes, Treatment, Diagnosis, Risk Factors and Complications

Mild dizziness due to low blood pressure

Also called postural hypotension – it is a form of low blood pressure that occurs when the person stands up after spending a lot of time sitting or lying down.

Orthostatic hypotension can make you feel dizzy or dizzy, and maybe even faint. It is usually mild, lasting for a few seconds or minutes after standing (orthostatic = erect body posture, hypo = less + tension = pressure).

However, when the hypotension is long lasting it can be a sign of more serious problems, so talk to your doctor if you frequently feel dizzy when standing up. It is even more urgent to go to the doctor if consciousness is lost, even momentarily.

Mild orthostatic hypotension often does not need treatment. Many people occasionally feel dizzy or dazed after getting up, and usually there is no cause for concern.

The treatment for the most severe cases of orthostatic hypotension depends on the cause.

The adequate supply of blood to the organs of the body depends on three factors:

  • A heart strong enough to pump.
  • Arteries and veins that can be contracted or compressed.
  • Sufficient blood and fluid inside the vessels.

When the body changes position, a variety of actions take place that involve all parts of the cardiovascular system, as well as the autonomic nervous system that helps regulate its function.

It can be considered that the autonomic nervous system “runs in the background” of the body, regulating the corporal processes that we take for granted.

There is a balance between the sympathetic system (adrenergic nerves), which speeds things up, and the parasympathetic system (cholinergic nerves) that slow things down. These names are based on the type of chemical substance that is used to transmit signals at the nerve endings.

Adrenaline (from the sympathetic nervous system) allows the body to respond to stress, imagine seeing a bear in the forest; your heart beats faster, your palms become sweaty, your eyes dilate and your hair bristles.

Acetylcholine is the anti-adrenaline chemical and is involved in the parasympathetic nervous system.

These two systems are balanced and, however, must respond to routine changes in the body that occur throughout the day.

When the body stands up, pressure monitors located in the carotid arteries and aorta perceive a subtle drop in blood pressure due to gravity, which causes blood to flow to the legs.

Almost immediately, the sympathetic system is stimulated, which increases the heart rate, causing the heart muscle to contract or tighten more strongly.

All these actions serve to increase blood pressure so that an adequate amount of blood can be pumped to the brain and other organs.

Without these changes, the severity would cause the blood to remain in the lower part of the body and away from the brain, causing symptoms of stunning or even fainting.

Orthostatic hypotension is not an illness or a complaint of an individual; it is an abnormal change in blood pressure and heart rate associated with a disease.

The symptoms

One of the most common symptoms of hypotension is a feeling of lightheadedness or dizziness when you stand up after sitting or lying down. This sensation, and other symptoms, occur after standing up and usually lasts only a few seconds.

Orthostatic hypotension signs and symptoms include:

  • Feeling dizzy or dizzy after getting up.
  • Blurry vision.
  • Daze.
  • Weakness.
  • Fainting (syncope).
  • Confusion.
  • Nausea.

These symptoms can resolve quickly as the body slowly adjusts to the standing position, but in some cases the patient must sit up or lie down quickly to avoid fainting or falling.

What are your causes?

Dehydration, fever, vomiting, not drinking enough fluids, severe diarrhea, and intense exercise with excessive sweating can lead to dehydration.

When you become dehydrated, your body loses blood volume. Dehydration can also cause symptoms of hypotension, such as weakness, fatigue, nausea and dizziness.

Heart problems. Heart diseases that can lead to blood pressure below the normal range include extremely low heart rate (bradycardia), heart valve problems, myocardial infarction, and heart failure.

These situations also cause orthostatic hypotension, since they prevent your body from being able to respond quickly enough to pump blood that is needed, which happens a lot when you stand up.

Endocrine problems Thyroid disorders, adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycaemia) and, in some cases, diabetes can cause low blood pressure. Diabetes can also damage nerves that help send signals that regulate blood pressure.

Nervous system disorders. Some nervous system disorders, such as Parkinson’s disease, multiple systemic atrophy, Lewy dementia, pure autonomic failure and amyloidosis, can disrupt your body’s normal blood pressure regulation system.

Some people experience low blood pressure after meals (postprandial hypotension). This condition is more common in older adults.

When should I call the doctor for orthostatic hypotension?

Feeling weak or dazed is not normal, although you can ignore a rare episode that can be explained by circumstances, such as working or exercising in the heat, you should investigate the most frequent occurrences.

If a person faints and is unconscious, even for a short period of time, it is never normal and access to medical care should be granted.

What is your treatment?

The treatment for orthostatic hypotension depends on the underlying diagnosis. If the cause is dehydration, fluid replacement will resolve the symptoms.

The treatments include:

Changes in lifestyle . Your doctor may suggest several lifestyle changes, including drinking enough fluids, such as water; drink little or no alcohol; avoiding walking in hot climates; raise the head of your bed; and standing up slowly. Your doctor may also suggest exercise programs to strengthen your leg muscles.

If you do not have high blood pressure, your doctor may suggest increasing the amount of salt in your diet. If your blood pressure drops after eating, your doctor may recommend small, low-carb meals.

Compression stockings . Compression stockings and abdominal garments or sashes can help reduce the accumulation of blood in the legs and reduce the symptoms of orthostatic hypotension.

Drugs . Several medications, whether used alone or together, can be used to treat hypotension. For example, fludrocortisone is often used to help increase the amount of fluid in the blood, which increases blood pressure.

Doctors often use medications to raise blood pressure levels. It works by limiting the ability of blood vessels to expand, which in turn increases blood pressure.

Some patients may be candidates for fludrocortisone to increase the volume of fluid in the blood vessels. Fludrocortisone is an adrenergic drug (that simulates adrenaline) that stimulates the sympathetic nervous system.

This medication has significant side effects, which include decreased levels of magnesium and potassium in the blood, headache, swelling and weight gain.

How is orthostatic hypotension diagnosed?

The key to the diagnosis is a good history and physical examination. The doctor will want to know the circumstances that are associated with the symptoms of dizziness or fainting, since it is unlikely that the patient has taken his blood pressure and checked his pulse in the middle of the episode.

The symptoms tend to be transient and resolve quickly. If there is a concern that the vital signs change with the position, the doctor will take the blood pressure in both lying and standing position and will look for changes.

It is advisable to pump the cuff first, then have the patient stand up and then begin to release the pressure.

According to the American Academy of Neurology, the formal diagnosis of orthostatic hypotension requires a 20 mm drop in systolic blood pressure or a 10 mm drop in diastolic blood pressure within three minutes of standing.

There is often an associated increase in heart rate, especially if the cause is dehydration or bleeding (if the patient takes a beta blocker, it is possible that the heart rate can not respond with an increase).

Blood tests may be ordered to look for the underlying cause. These may include a count of red blood cells to access anemia or bleeding.

Electrolytes can be controlled, especially if there has been a history of fluid loss from vomiting or diarrhea, since sodium and potassium abnormalities can be a problem. Renal function can be evaluated.

If the physical examination reveals concern about the heart, an electrocardiogram can be performed to assess electrical conduction and heart rate.

An echocardiogram or an ultrasound of the heart can be ordered to evaluate the heart valves and evaluate the function of the heart muscle. It can be considered an exercise test if there is concern about coronary artery disease.

An inclination table test may be ordered with the head high if symptoms of orthostatic hypotension continue to occur, but it has been difficult to document abnormalities in the blood pressure readings.

During the test, the patient is tied to a table and, as the table is gradually tilted at an angle of 70 or 80 degrees, continuous readings of blood pressure and heart rate are taken.

The patient can be left on the table for more than 10 minutes to observe the delayed changes observed in postural orthostatic tachycardia syndrome.

For many patients, the diagnosis can be made on the basis of history and physical examination, and no further testing is necessary.

Risk factor’s

Orthostatic hypotension occurs more frequently in the elderly. “Hardening of the arteries” or atherosclerosis that develops as we get older makes it harder for blood vessels to adapt quickly when needed.

In addition, many of the diseases that are associated with orthostatic hypotension are progressive and the symptoms worsen with age.

Pregnancy is associated with orthostatic hypotension, as it progresses, the volume of the circulatory system expands and blood pressure tends to decrease.

This can lead to dizziness when standing up quickly. Blood pressure levels return to normal after delivery.

Excessive sweating due to physical exertion and exposure to heat are risk factors and possible causes of dehydration and symptoms of orthostatic hypotension.

Patients who have other risk factors for orthostatic hypotension are more likely to become even slightly dehydrated.

Chronic alcohol consumption and drug abuse are also risk factors for developing symptoms of orthostatic hypotension.

Complications

The drop in blood pressure is the most important complication of orthostatic hypotension.

Very often, the symptoms are transient and self-limiting, which gives the patient the opportunity to sit down, but when the fall in blood pressure causes syncope (fainting) or almost syncope, it is the trauma that remains in the fall that causes most of the damage

Prevention

Since dehydration is the most common cause of orthostatic hypotension, it is important to minimize the risk by staying adequately hydrated.

This is especially important if an individual works or exercises in a hot environment. Fluid lost through vomiting, diarrhea, and other diseases that are associated with fever should be replaced as much as possible.

Patients taking new medications that may affect the autonomic nervous system should be aware of the potential for orthostatic hypotension and report any symptoms to their doctor.