Orthostatic hypotension

Overview

Orthostatic hypotension, also known as postural hypotension, is a condition where blood pressure drops significantly upon standing from a sitting or lying position, leading to symptoms like dizziness, lightheadedness, and even fainting. While episodes can be mild and brief, persistent orthostatic hypotension may indicate underlying health issues, making it crucial to consult a healthcare provider if symptoms are frequent.

Transient orthostatic hypotension often results from identifiable causes such as dehydration or prolonged immobilization and can be readily managed. However, when orthostatic hypotension is chronic, it typically suggests the presence of another medical condition, requiring a treatment approach that addresses the root cause.

Symptoms

Orthostatic hypotension often occurs more commonly and intensely in the morning, as blood pressure typically reaches its lowest levels upon waking. While some individuals may not notice any symptoms of orthostatic hypotension, others might find that their symptoms intensify in warm conditions, such as in hot weather, during a fever, or after using a hot tub or shower. The primary indicator of this condition is feeling dizzy or lightheaded upon standing, which usually improves when sitting or lying down. In some cases, individuals may faint (experience syncope).

Additional symptoms of orthostatic hypotension can include:

• Blurred vision
• Chest pain.
• Confusion or difficult to concentrate.
• Fainting (syncope)
• Fatigue or weakness.
• Headache.
• Shortness of breath or dyspnea.

It’s crucial to consult with a healthcare professional if you frequently experience symptoms of orthostatic hypotension. Losing consciousness, even briefly, is a serious matter that necessitates immediate medical attention. Keeping a detailed log of your symptoms, including their timing, duration, and activities at the time they occur, is beneficial. Make sure to inform your healthcare provider if you experience symptoms in potentially hazardous situations, such as while driving.

Causes

Orthostatic hypotension, a condition where blood pressure significantly drops upon standing up from sitting or lying down, results from the body’s inability to quickly adjust blood pressure in response to gravity’s effects. Normally, when you stand, gravity causes blood to pool in your legs and abdomen, leading to a temporary drop in blood pressure. The body compensates for this by having baroreceptors—specialized cells near the heart and in the neck arteries—detect the reduced blood pressure. These cells signal the brain to increase heart rate and constrict blood vessels, thus stabilizing blood pressure.

However, various factors can interfere with this compensatory mechanism, leading to orthostatic hypotension. These include:

• Dehydration: Loss of fluids from fever, vomiting, insufficient fluid intake, severe diarrhea, or heavy exercise with excessive sweating reduces blood volume, which can cause symptoms like weakness, dizziness, and fatigue.
• Endocrine disorders: Issues with the thyroid, adrenal insufficiency (Addison’s disease), and low blood sugar (hypoglycemia) can lead to orthostatic hypotension. Diabetes can also contribute by damaging nerves that regulate blood pressure.
• Heart problems: Conditions such as bradycardia (very low heart rate), heart valve issues, heart attack, and heart failure impair the heart’s ability to pump blood effectively, especially upon standing.
• Nervous system disorders: Diseases like Parkinson’s disease, multiple system atrophy, Lewy body dementia, pure autonomic failure, and amyloidosis can hinder blood pressure control.
• Postprandial hypotension: Some individuals experience a drop in blood pressure after eating, more commonly observed in older adults.

Risk factors

An orthostatic hypotension can affect anyone. As you become older, the disease becomes more common. The following factors may increase the risk:

• Age: People who are 65 years of age and older frequently experience orthostatic hypotension. As you age, some baroreceptors cells may become less active. An aged heart may also have a harder time pumping quickly enough to compensate for drops in blood pressure.
• Medications: Among them are medicines used to treat heart disease or high blood pressure, such as nitrates, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, alpha, beta, and beta blockers.

The following medications could increase the risk of orthostatic hypotension which includes opioids, muscle relaxants, antidepressants, antipsychotics, Parkinson’s disease medicines, and certain antidepressants.

• Certain diseases:  A number of cardiac diseases, such as heart valve issues, heart attacks, and heart failure, could increase the likelihood of low blood pressure. They also include conditions affecting the nerve system, such Parkinson’s disease. And they include conditions like diabetes that result in neuropathy, or damage to the nerves.
• Heat exposure: Excessive sweating and possible dehydration brought on by a hot environment might drop blood pressure and cause orthostatic hypotension.
• Lying in bed: Weakness might result from spending a lot of time in bed due to an illness or accident. A result of this could correspond to orthostatic hypotension. Pregnancy could also prolong the bed rest of the patient.
• Alcohol intake: The risk of orthostatic hypotension can increase with consumption of alcohol.