Orthostatic Hypotension

12 min read

Orthostatic hypotension (OH) is a medical condition in which a person's blood pressure drops when they stand up from a sitting or lying down position. It is also known as postural hypotension. OH is caused by a sudden decrease in blood pressure when a person stands up, resulting in a decrease in blood flow to the brain. This can cause dizziness, lightheadedness, and even fainting. OH is a common condition, especially in older adults, and can be caused by a variety of medical conditions and medications.

Causes of Orthostatic Hypotension

OH can be caused by a variety of medical conditions, including diabetes, dehydration, heart problems, and certain medications. It can also be caused by a sudden change in posture, such as standing up too quickly. Other causes of OH include pregnancy, anemia, and certain neurological conditions.

Diagnosis of Orthostatic Hypotension

OH is typically diagnosed by a physical exam and a review of the patient's medical history. The doctor may also order blood tests and other tests to rule out other medical conditions. In some cases, the doctor may also order a tilt table test, which is used to measure a person's blood pressure while they are in different positions.

Complications of Orthostatic Hypotension

OH can lead to a variety of complications, including falls, injuries, and even death. It can also lead to fatigue, confusion, and difficulty concentrating. In some cases, OH can also lead to an increased risk of stroke and heart attack.

Prevention of Orthostatic Hypotension

OH can be prevented by making lifestyle changes, such as drinking plenty of fluids, eating a healthy diet, and exercising regularly. It is also important to avoid standing up too quickly, and to take medications as prescribed by a doctor. In some cases, a doctor may also prescribe medications to help prevent OH.

Symptoms

Common Symptoms of Orthostatic Hypotension

  • Dizziness
  • Lightheadedness
  • Blurred vision
  • Fainting
  • Nausea
  • Weakness
  • Headache
  • Fatigue
  • Palpitations
  • Confusion

Less Common Symptoms of Orthostatic Hypotension

  • Sweating
  • Chest pain
  • Shortness of breath
  • Abdominal pain
  • Numbness or tingling in the extremities

When to See a Doctor

If you experience any of the symptoms of orthostatic hypotension, it is important to see a doctor as soon as possible. Your doctor can help diagnose the condition and recommend treatment options. In some cases, orthostatic hypotension can be a sign of a more serious underlying condition, such as heart disease or diabetes.

Take the Orthostatic Hypotension Assessment

Causes

Dehydration

Dehydration can cause a decrease in blood volume, which can lead to a drop in blood pressure when standing. This is especially true if the person has been exercising or sweating heavily. It is important to drink plenty of fluids throughout the day to prevent dehydration.

Medications

Certain medications can cause a decrease in blood pressure when standing. These include medications for high blood pressure, heart disease, depression, and Parkinson's disease. It is important to talk to your doctor about any medications you are taking and their potential side effects.

Age

As people age, their bodies become less able to adjust to changes in position. This can lead to a decrease in blood pressure when standing. Older adults are more likely to experience orthostatic hypotension than younger people.

Medical Conditions

Certain medical conditions can also contribute to orthostatic hypotension. These include diabetes, anemia, and thyroid disorders. It is important to talk to your doctor if you have any of these conditions to determine if they are contributing to your symptoms.

Lifestyle Factors

Certain lifestyle factors can also contribute to orthostatic hypotension. These include smoking, drinking alcohol, and not getting enough sleep. It is important to make healthy lifestyle choices to reduce your risk of developing orthostatic hypotension.

Getting a Diagnosis

Medical History

The first step in diagnosing orthostatic hypotension is to take a detailed medical history. Your doctor will ask about any symptoms you have experienced, such as dizziness, lightheadedness, or fainting. They will also ask about any medications you are taking, as some medications can cause or worsen orthostatic hypotension. Your doctor may also ask about any other medical conditions you have, as some conditions can increase your risk of developing orthostatic hypotension.

Physical Exam

Your doctor will also perform a physical exam to look for signs of orthostatic hypotension. They will check your blood pressure while you are lying down and then again while you are standing up. They may also check your heart rate and breathing rate. Your doctor may also check your reflexes and look for signs of dehydration.

Tilt Table Test

If your doctor suspects that you have orthostatic hypotension, they may order a tilt table test. This test involves lying on a table that is tilted at an angle. Your doctor will measure your blood pressure and heart rate while you are lying on the table and then again while you are standing up. This test can help diagnose orthostatic hypotension.

Other Tests

Your doctor may also order other tests to help diagnose orthostatic hypotension. These tests may include blood tests to check for anemia or other conditions that can cause orthostatic hypotension. Your doctor may also order an electrocardiogram (ECG) to check for any heart problems. They may also order an imaging test, such as an MRI or CT scan, to look for any underlying conditions that may be causing your symptoms.

Conclusion

Diagnosing orthostatic hypotension is important to ensure proper treatment and management of the condition. Your doctor will take a detailed medical history and perform a physical exam. They may also order a tilt table test or other tests to help diagnose the condition. If you have any symptoms of orthostatic hypotension, it is important to talk to your doctor.

Questions for Your Doctor

Symptoms

Be sure to tell your doctor about any symptoms you have been experiencing. This includes dizziness, lightheadedness, blurred vision, fatigue, and fainting. It is also important to note if you have been feeling any chest pain or palpitations.

Medications

Your doctor will want to know what medications you are currently taking. This includes any over-the-counter medications, supplements, and herbal remedies. Be sure to mention any recent changes in your medication regimen.

Lifestyle Changes

Your doctor may suggest making some lifestyle changes to help manage your orthostatic hypotension. This could include increasing your salt intake, drinking more fluids, and avoiding alcohol and caffeine. Your doctor may also suggest increasing your physical activity and avoiding prolonged standing.

Follow-Up Appointments

Your doctor may want to schedule follow-up appointments to monitor your condition. This will allow them to adjust your treatment plan if necessary. Be sure to ask your doctor about any questions or concerns you may have.

Treatment

Lifestyle Changes

Making lifestyle changes can help reduce the symptoms of orthostatic hypotension. These changes include:

  • Drinking plenty of fluids, especially water
  • Eating smaller, more frequent meals
  • Avoiding alcohol and caffeine
  • Wearing compression stockings
  • Avoiding sudden changes in position
  • Exercising regularly
  • Sleeping with the head of the bed elevated

Medications

In some cases, medications may be prescribed to help manage orthostatic hypotension. These medications may include:

  • Fludrocortisone, which helps the body retain salt and water
  • Midodrine, which helps constrict blood vessels and increase blood pressure
  • Erythropoietin, which helps increase red blood cell production
  • Droxidopa, which helps increase norepinephrine levels

Other Treatments

In some cases, other treatments may be recommended to help manage orthostatic hypotension. These treatments may include:

  • Physical therapy to help improve balance and strength
  • Counseling to help manage stress and anxiety
  • Biofeedback to help control the body's response to stress
  • Vasopressin injections to help increase blood pressure

If you are experiencing symptoms of orthostatic hypotension, it is important to speak to your doctor to determine the best treatment plan for you.

Drugs & Medications

Medications for Orthostatic Hypotension

The most common medications used to treat orthostatic hypotension are fludrocortisone, midodrine, and droxidopa. Fludrocortisone is a type of steroid that helps to increase blood pressure by increasing the amount of salt and water in the body. Midodrine is a drug that helps to constrict the blood vessels, which helps to increase blood pressure. Droxidopa is a drug that helps to increase the production of norepinephrine, a hormone that helps to regulate blood pressure.

Other Treatments for Orthostatic Hypotension

In addition to medications, there are other treatments that can help to reduce the symptoms of orthostatic hypotension. These include lifestyle changes such as increasing salt intake, avoiding alcohol and caffeine, and wearing compression stockings. Regular exercise can also help to improve circulation and reduce symptoms. In some cases, physical therapy may be recommended to help improve balance and coordination.

Conclusion

Orthostatic hypotension can be a serious condition, but it can be managed with the right treatment. Medications such as fludrocortisone, midodrine, and droxidopa can help to reduce symptoms. In addition, lifestyle changes and physical therapy can also help to improve circulation and reduce symptoms. If you are experiencing symptoms of orthostatic hypotension, it is important to speak to your doctor to determine the best treatment plan for you.

Diet

Increase Salt Intake

Increasing your salt intake can help reduce the symptoms of orthostatic hypotension. This is because salt helps to retain fluid in the body, which can help to increase blood pressure. It is important to note that too much salt can be harmful, so it is important to talk to your doctor before increasing your salt intake.

Increase Water Intake

Increasing your water intake can also help to reduce the symptoms of orthostatic hypotension. This is because water helps to increase blood volume, which can help to increase blood pressure. It is important to note that drinking too much water can be dangerous, so it is important to talk to your doctor before increasing your water intake.

Increase Fiber Intake

Increasing your fiber intake can also help to reduce the symptoms of orthostatic hypotension. This is because fiber helps to regulate blood sugar levels, which can help to increase blood pressure. It is important to note that too much fiber can be harmful, so it is important to talk to your doctor before increasing your fiber intake.

Avoid Caffeine and Alcohol

Caffeine and alcohol can both cause a sudden drop in blood pressure, so it is important to avoid them if you have orthostatic hypotension. It is also important to note that caffeine and alcohol can both be dehydrating, so it is important to drink plenty of water if you do consume them.

Conclusion

While there is no specific diet to treat orthostatic hypotension, there are certain dietary changes that can help reduce symptoms. Increasing your salt, water, and fiber intake can all help to reduce the symptoms of orthostatic hypotension. It is also important to avoid caffeine and alcohol, as they can both cause a sudden drop in blood pressure. If you have any questions or concerns about your diet, it is important to talk to your doctor.

Lifestyle

Stay Hydrated

Staying hydrated is essential for managing orthostatic hypotension. Dehydration can cause a drop in blood pressure, so it’s important to drink plenty of fluids throughout the day. Aim for at least 8 glasses of water per day, and avoid drinks with caffeine or alcohol, as these can further dehydrate the body.

Eat Regularly

Eating regular meals can help keep your blood sugar levels stable, which can help prevent drops in blood pressure. Eating small, frequent meals throughout the day can also help keep your energy levels up and prevent dizziness or lightheadedness.

Exercise Regularly

Regular exercise can help improve circulation and reduce the risk of orthostatic hypotension. Aim for at least 30 minutes of moderate exercise per day, such as walking, jogging, or swimming. If you’re just starting out, start with shorter, less intense workouts and gradually increase the intensity and duration.

Wear Compression Stockings

Compression stockings can help improve circulation and reduce the risk of orthostatic hypotension. These stockings are designed to apply pressure to the legs, which can help keep blood from pooling in the lower extremities. Talk to your doctor about the best type of compression stockings for you.

Avoid Standing for Long Periods

Standing for long periods of time can cause a drop in blood pressure, so it’s important to take breaks throughout the day. If you have to stand for long periods, try to move around every few minutes to keep your circulation going. You can also try sitting down for a few minutes every hour to give your body a break.

Get Enough Sleep

Getting enough sleep is essential for managing orthostatic hypotension. Aim for at least 7-8 hours of sleep per night, and try to go to bed and wake up at the same time each day. Avoid caffeine and alcohol before bed, as these can interfere with your sleep.

Conclusion

Orthostatic hypotension can be managed with lifestyle changes. Staying hydrated, eating regularly, exercising, wearing compression stockings, avoiding standing for long periods, and getting enough sleep can all help reduce the risk of orthostatic hypotension.