Stress is a general term used to define the response of the body against a situation, threat, danger, etc. It may be of many types like emotional stress, physical stress, etc. When considering the possibility of getting syncope or orthostatic hypotension due to any of the stress experienced by the body, the answer is yes.
Can Stress/Anxiety Cause Orthostatic Hypotension?
Any type of stress can lead to orthostatic hypotension but it is not always true. There are various defense mechanisms made by the body against such symptoms but if a person is having some defect in such compensatory mechanisms then it is very common to develop the symptoms of orthostatic hypotension.
Firstly, the example of emotional stress/ anxiety is considered. When a person experiences a sudden burst of emotion which may be shock, anger, danger, love, or any other emotion then there are a lot of changes that our body undergoes at the same time. Usually, when a person is angry there is a rise in blood pressure but in other emotions, there may be the opposite scenario.
While experiencing any other emotion there is an increased heart rate to maintain the rising demands of the body in the phase of stress which increases the blood supply to all the body parts. But at the same time to manage the oxygen demand of the body, there is an increased rate of ventilation also. When the person hyperventilates there is increased dilation of the blood vessels in the whole body except in the brain.(1) There is sudden carbon dioxide washout from the body and the increased vasodilation causes the pooling of the blood in peripheral vessels. It overcompensates the compensatory mechanism of the increase in heart rate and decreases the blood flow to the cerebral blood vessels.(2)
Also due to cerebral vasoconstriction, there is decreased blood flow in the brain.(3) Such a situation causes abrupt fall in the functioning of the brain and the person feels lightheadedness. The blood pressure also falls and there are orthostatic hypotension and syncope.
Now in the case of physical stress such as rigorous exercise, hyperactive sports, international tournaments, due to high-performance pressure as well as body requirements there is an increased need for glucose /energy source as well as oxygen to the muscles. To meet such demands, the body tries it by doing vasodilation and increasing the heart rate because it will lead to high blood flow to the whole of the body and the required products can be delivered efficiently. But when there is the peak reached, the compensatory mechanism will begin to fall apart in a fraction of second. This will lead to excessive vasodilation and the blood will not be sufficient to be pumped by the heart. It will again lead to orthostatic hypotension and the person will fall when he attempts to perform the activity.
In cases of environmental stress such as high surrounding temperature, suffocating atmosphere, inadequate air supply, excessive humidity, etc. then it can be very difficult for the body to compensate for all conditions at one time. If there is profuse sweating and a high amount of water loss is occurring, then the blood volume will decrease rapidly and even the increase in heart rate will not be able to compensate for the loss of volume.(4) If the person is not able to respire adequately then to meet the oxygen demands the body will try to hyperventilate and there will be vasodilation in the whole body. These features will again lead to a fall in blood pressure due to the pooling of the blood in peripheral vessels and will cause orthostatic hypotension.
It is a very familiar phenomenon to observe that stress can cause orthostatic hypotension because it can lead to disruption of the compensatory mechanisms of the body. So, it is possible that anxiety/ stress can cause orthostatic hypotension.
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