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Orthostatic Hypotension

(Postural Hypotension)

Definition

Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.
Measuring of Blood Pressure
Placement of Blood Pressure Cuff
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Causes

As you stand, blood falls toward your lower body in response to gravity. To help keep blood in the upper body:
Blood pressure is also affected by the amount of blood in the blood vessels. Low levels of blood will decrease the blood pressure and make it harder for the body to compensate when you stand. Low blood volume, called hypovolemia, is the most common cause of orthostatic hypotension. It may be due to:
Orthostatic hypotension will occur when 1 or more of these factors do not work as expected. It may be associated with:

Risk Factors

Factors that increase your chance of orthostatic hypotension include:

Symptoms

Orthostatic hypotension may cause:
Exercise or having eaten a heavy meal may worsen symptoms.

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.

Treatment

When possible, treatment will focus on resolving the orthostatic hypotension completely. If a complete resolution is not possible, treatment will focus on managing symptoms.

Resolving Symptoms

Treatment will depend on the cause. Examples include:
  • Adjusting or stopping medications that cause problems.
  • Avoiding prolonged bed rest. Make sure to sit up each day. Start slowly and increase the time and frequency.
  • Preventing dehydration by increasing fluid and electrolyte intake.

Managing Symptoms

Common approaches include:
The doctor may recommend prescription medications to increase blood pressure.
Dietary changes may also help increase blood pressure or prevent very low blood pressure. A dietitian may help create a diet plan. Steps may include:
  • Increasing salt intake.
  • Eating smaller, more frequent meals with fewer carbohydrates that may help to avoid low blood pressure after eating.
  • Limiting or eliminating alcohol.
Behavioral changes that may help include:
  • Using fitted elastic stockings that go up to the waist.
  • Learning to slowly move from a lying or sitting position to a sitting or standing position.
  • Avoiding sitting or standing still for prolonged periods of 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 bedrest, you should talk with your healthcare provider about treatment options.

RESOURCES

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

National Organization for Rare Disorders http://www.rarediseases.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Heart and Stroke Foundation http://www.heartandstroke.ca

References

Berkow R, Beers MH, eds. The Merck Manual of Medical Information—Home Edition. 2nd ed. Simon and Schuster, Inc; 2003.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 8th ed. St. Louis, MO: Mosby; 2006.

Goldman L. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: Saunders; 2004.

Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: Diagnosis and treatment. Am J Med. 2007;120:841-847.

Lenders JW, Eisenhofer G, et al. Phaeochromocytoma. Lancet. 2005;366:665-675.

National Institute of Neurological Disorders and Stroke website (NINDS) orthostatic hypotension information page. Available at: http://www.ninds.nih.gov/disorders/orthostatic%5Fhypotension/orthostatic%5Fhypotension.htm. Updated September 30, 2011. Accessed August 21, 2014.

Orthostatic syncope. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 25, 2014. Accessed August 21, 2014.

Shibao C, Grijalva CG, et al. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120:975-980.

3/24/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills PB, Fung CK, et al. Nonpharmacologic management of orthostatic hypotension: A systematic review. Arch Phys Med Rehab. 2015;96(20):366-375.

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