Is Orthostatic Hypotension A Serious Condition & Can It Be Reversed?

In orthostatic hypotension, doctors mean a drop in blood pressure below normal values ​​when a person suddenly gets up from a sitting or lying position. An orthostatic drop in blood pressure develops due to an inadequate response of the cardiovascular system to a change in the position of the body. 

This inadequate response does not constitute a sufficiently rapid narrowing of the blood vessels in the lower body, which is necessary to maintain normal blood pressure while standing. As a result, the blood lasts longer in the vessels of the legs, it returns to the heart in smaller quantities, which leads to a decrease in cardiac output and blood pressure.(1)

Is Orthostatic Hypotension A Serious Condition?

In moderate cases, it is not a serious issue and may get resolved after some time. But sometimes it may be a symptom of more serious underlying pathologies or disorders. So, if there is no specific cause of orthostatic hypotension, such as excessive stress, strenuous exercise in hot conditions or fatigue due to several reasons, and if the incidence happens frequently, you should consult your physician at the earliest.

Orthostatic hypotension is mainly manifested by dizziness and lightheadedness when you get up. In some cases, people with orthostatic hypotension may pass out.

Other symptoms include:

These symptoms usually go away when you sit or lie down for a few minutes.(2)(3)

Demonstrating orthostatic hypotension sometimes requires repeated measurements during several visits, at different times of the day. The abnormal blood pressure response is only detectable from time to time by extending the standing position beyond three minutes.

This should be taken into account when the patient reports symptoms of late-onset, after prolonged static posture. It is in the morning upon waking that orthostatic hypotension is generally the most severe. The reason is a relative contraction of the circulating volume as a consequence of pressure natriuresis occurring in the supine position during sleep and the resulting better venous return.

The history and clinical examination most often allow to specify the cause of orthostatic hypotension:

  • It may be hypovolemia (dehydration, vomiting, diarrhea, hemorrhage, adrenal insufficiency). Orthostatic hypotension can be exacerbated, especially in the elderly with a decrease in the sensitivity of the baroreflex, through meals (via a redirection of blood volume to the splanchnic circulation) and alcohol (vasodilation).
  • Deonditioning (prolonged bed rest, physical handicap).
  • Medication is often involved: antihypertensives, especially diuretics, α-blockers (don’t forget those used to treat prostate hyperplasia) and vasodilators; dopamine agonists; venous vasodilators; antidepressants (especially tricyclic antidepressants) and antipsychotics.
  • Neurogenic causes (Parkinson’s disease, neurodegenerative disorders, peripheral neuropathies). Certain symptoms should lead to a particular search for an attack of this type (urinary retention, constipation, decreased sweating, erectile dysfunction). These symptoms are non-specific and very common in the elderly.(4)

Can Orthostatic Hypotension Be Reversed?

When the underlying problem is found out and resolved then orthostatic hypotension is automatically reversed. Non-pharmacological measures are an integral part of the treatment of orthostatic hypotension. None is a panacea but it is often possible to significantly improve the symptomatology by combining them:

Increase the consumption of NaCl from 6 to 10 grams/day and the drinks from 1.5 to 2 liters/day.

Encourage the return of blood to the heart (do not get up suddenly, do not stand without moving, cross your legs while standing, contract the leg muscles).

Perform isometric contractions of the upper and/or lower limbs for two minutes before getting up. These maneuvers lead to sympathetic vascular activation, thus temporarily increasing the vascular tone, which makes it possible to limit the symptoms when the position changes.

Wear an abdominal sheath or compression stockings to decrease the blood volume remaining in the splanchnic circulation and the venous system of the lower extremities.

Exercise regularly. Training in water is particularly beneficial due to the pressure exerted by water on the body, thus facilitating venous return. Lying down is better than standing up.

One way to increase blood pressure in 5 to 10 minutes, and this for about 30 minutes, is to drink 450 ml of water in three to four minutes. This effect is probably due more to an activation of the sympathetic system linked to the hypotonicity of the water than to an effect on the blood volume.(5)

Orthostatic Hypotension And Medical Treatment

Certain drugs increase the risk of orthostatic hypotension and should, if possible, be avoided. When seizures are frequent, doctors prescribe fludrocortisone, non-steroidal anti-inflammatory drugs, an ergot derivative, midodrine or dihydroergotamine.

References:

  1. Arnold AC, Raj SR. Orthostatic hypotension: a practical approach to investigation and management. Canadian Journal of Cardiology. 2017;33(12):1725-1728.
  2. Espay AJ, LeWitt PA, Hauser RA, Merola A, Masellis M, Lang AE. Neurogenic orthostatic hypotension and supine hypertension in Parkinson’s disease and related synucleinopathies: prioritisation of treatment targets. The Lancet Neurology. 2016;15(9):954-966.
  3. Suraj R, Hodge S, Spence EE, et al. Cerebrovascular Consequences of Chronic Orthostatic Hypotension. The FASEB Journal. 2019;33(1_supplement):533.516-533.516.
  4. Rosario MG, Gonzalez M. Orthostatic Hypotension in People with Human Immunodeficiency Virus. The FASEB Journal. 2018;32(1_supplement):517.511-517.511.
  5. Hale GM, Valdes J, Brenner M. The treatment of primary orthostatic hypotension. Annals of Pharmacotherapy. 2017;51(5):417-428.

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