How Do You Check For Orthostatic Hypotension & What Is The Best Medicine For It?

The hypotension is characterized by a blood pressure abnormally low. It is, in a way, the reverse of hypertension. This low pressure of blood may be frequent, transient, occasional or constant. It may be regarded as a symptom rather than an illness. The causes of hypotension are multiple: neurological problems, the side effects of a drug, dehydration, etc..(1)

How Do You Check For Orthostatic Hypotension?

The sudden drop in blood pressure can be accompanied by dizziness and weakness for a few seconds and sometimes fainting. Often, such symptoms appear when an individual gets up fast from a sitting/lying position. Just like heart rate or body temperature, pressure must be kept at a relatively constant level to keep the body functioning properly.

People of all ages can experience symptoms of low blood pressure occasionally, including healthy young adults. However, people over 65 are the most often affected. About 20% of the elderly suffer from this disorder frequently due to different causes. It is therefore important to consult a doctor to find the cause. Individuals who are bedridden and pregnant women experience this symptom more often.(2)

What Is The Best Medicine For Orthostatic Hypotension?

The most often prescribed medication is fludrocortisone: it causes an increase in blood volume. Midodrine can also be used 30 minutes before getting up, for example, and then 2 or 3 times a day. 

Pyridostigmine may also be prescribed for mild hypotension. Also, medications that slow the emptying of the stomach can help treat postprandial hypotension in people with diabetes. 

In all cases, close monitoring should be done by the doctor to avoid sudden increases in blood pressure. As a last resort, the installation of an electron systolic trainer (pacemaker) can help treatment by increasing the basic heart rate.(3)

Basic Preventive Measures

In the case of orthostatic hypotension:

  • Get up slowly. Before getting up from the bed, stretch and sit for 1 minute on the edge of the bed. Also, avoid getting up quickly from a chair or armchair.
  • Drink water and other drinks regularly. In hot weather, in people who take diuretics and limit their salt intake, the intake of water and salt can prevent hypotension. It is better to consult a physician though.
  • Avoid drinking alcohol. Even when consumed in moderation, it can contribute to hypotension.
  • Avoid using cannabis (marijuana).
  • Avoid hot environments as it may dilate the blood vessels thereby increasing sweating that may result in blood pressure drop.
  • Eat slightly salty food. This can help people who usually avoid the salts, but it is not a general recommendation. Salt causes water retention. But take a physician’s advice before increasing the intake of salts.
  • Leave the legs uncrossed. When seated, crossing your legs creates pressure on the veins and forces the blood to stay in your lower body.
  • If necessary, wear compression stockings.
  • Avoid physical exertion when it is too hot.
  • Quickly drink 500 ml of cold water to increase blood volume, when a long-standing position is necessary (shopping, for example).

In case of heart problems or hypertension, see your doctor regularly so that he can properly adjust the dosage of the treatment. If you suspect that taking a medication is causing low blood pressure, talk to your doctor.

In case of postprandial hypotension:

  • Do not drink alcohol before and after meals.
  • Avoid meals that are too large: favor lighter and more frequent meals, not too rich in sugar.
  • A walk after a meal can help but avoid physical exertion.

Drinking coffee or tea at the end of a meal reduces postprandial hypotension because caffeine increases blood pressure. However, it is recommended not to increase your consumption of coffee without first talking to your doctor.(4)(5)

References:

  1. Schott CK, Fozard JA. Hypotension and Shock. Rapid Response System: A Practical Guide. 2018:75.
  2. Ricci F, Manzoli L, Sutton R, et al. Hospital admissions for orthostatic hypotension and syncope in later life: insights from the Malmö Preventive Project.
  3. Journal of hypertension. 2017;35(4):776-783.

  4. Hale GM, Valdes J, Brenner M. The treatment of primary orthostatic hypotension. Annals of Pharmacotherapy. 2017;51(5):417-428.
  5. Liguori I, Russo G, Coscia V, et al. Orthostatic hypotension in the elderly: a marker of clinical frailty? Journal of the American Medical Directors Association. 2018;19(9):779-785.
  6. Hewitt LA, Adler CH, Claassen DO, Gibbons CH, Raj SR. Management and Treatment of Neurogenic Orthostatic Hypotension: Results From a Survey of Patients and Caregivers (P2. 130). AAN Enterprises; 2018.

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