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Overview

Orthostatic Hypotension, also known as Postural Hypotension, is a condition wherein the blood pressure drops below normal on assuming an upright posture from a lying-down posture.

Understanding the ailment

Blood pressure is the pressure exerted by blood on blood vessels. Normal blood pressure ensures adequate blood flow to our organs. It is affected by the following parameters:

  • Heartbeats per minute
  • Amount of blood pumped by the heart per contraction

Our body has advanced mechanisms to make sure that our blood pressure remains within the normal range. When we get up from a lying down posture, our blood pools in the veins of our legs, due to the effect of gravity. Thus, the amount of blood returning to the heart decreases, decreasing the blood pumped by the heart. This is sensed by the arteries, which signal the heart to pump faster, to maintain the blood pressure.

In a patient of Postural Hypotension, there is a defect in this mechanism, due to which their body is unable to maintain their blood pressure, leading to low BP on resuming an upright posture.

Probability: Very common

Symptoms

Symptoms occur due to decreased blood flow to vital organs like brain.

  • Light headedness or dizziness on standing up (most common)
  • Fainting episodes / blackouts
  • Blurred vision
  • Weakness
  • Confusion
  • Neck pain and backache

Who is at risk

  • Elderly population, above 65 years (common cause of fainting in this age group): BP maintaining mechanisms slow down as age advances.
  • People on certain medications: BP lowering drugs, anti-depressants, muscle relaxants, anti-psychotics.
  • People with Certain diseases: Heart valve problems, heart failure, diabetes, Parkinson’s disease.
  • Bed rest and bed-ridden patients
  • Alcoholics

Causes

Postural Hypotension is mainly caused due to ineffective blood pressure maintaining mechanisms that can occur in:

  • Fluid loss: Dehydration, loose motions, vomiting
  • Heart problems: Heart valve problem, heart failure, etc.
  • Hormonal imbalance: Thyroid conditions, adrenal insufficiency
  • Diabetes Mellitus
  • Drug induced: BP lowering drugs, anti-depressants, anti-psychotics

Complications

Persistent postural Hypotension can cause serious  complications, especially in older adults:

  • Falls: Postural Hypotension can cause falls due to its symptoms and result in frequent fractures
  • Cardiovascular diseases: It can be a risk factor for chest pain
  • Stroke: Reduced blood supply to the brain due to low BP is a risk factor for the development of stroke

Diagnosis

Your doctor will diagnose this condition based on the following:

  • Blood pressure monitoring: Measurement of BP while lying down posture and then in standing up posture.
  • Tilt table test: You will lie on a flat table that tilts to lift your upper body. Your BP will be measured simultaneously.
  • Stress test: This test measures the activity of your heart when it is subjected to stress such as exercise. You will be required to walk on a treadmill for a few minutes after which a 2D-ECHO will be done to assess your hearts activity.
  • ECG: Done to rule out any heart rhythm abnormality.
  • Blood tests: Blood sugar levels and blood hemoglobin levels.

Treatment

Treatment focuses on maintaining a normal blood pressure and preventing conditions which lead to low BP like medications that increase BP (sympathomimetics, steroid preparations).

 Prevention

  • Elevate head of bed at night
  • Wear pressure stockings to avoid pooling of blood in the legs
  • Drink adequate amount of water, ORS (in case of loose stools and vomiting)
  • Limit consumption of alcohol
  • Stand up slowly
  • Increase amount of salt in diet

Consult your physician for diagnosis and treatment.

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