Orthostatic hypotension is one of the varieties of arterial hypotension (AHT) characterized by a drop in blood pressure with a quick translation of the body position from horizontal to a vertical position.(1)
What Is Orthostatic Hypotension Caused By?
Dehydration: It develops when the intake of fluid in the body does not correspond to its loss. The main causes of dehydration are vomiting, diarrhea, fever, overheating, and treatment with diuretics.
Blood Loss And Other Causes Of Anemia: Reducing the number of red blood cells that carry oxygen can lead to the development of symptoms of hypotension.
Heart Disease: Very low heart rate, problems with heart valves, heart failure can lead to orthostatic hypotension.
Endocrine Problems: A decrease in blood pressure can be caused by adrenal insufficiency, low blood sugar, and diabetes. Diabetes can also damage nerves to help send out signals that regulate blood pressure.
Disorders Of The Nervous System: Some nervous diseases can upset the regulation of blood pressure in the body such as Parkinson’s disorder, amyloidosis, autoimmune conditions, and other similar situations.
Beta-Blockers: These are medicines used to lower blood pressure. Their use affects the body’s ability to adapt to changes in body position.
Sildenafil (Viagra), Vardenafil (Levitra) And Tadalafil (Cialis): These are drugs that are used for erectile dysfunction. They dilate blood vessels, which can cause orthostatic hypotension. These effects are enhanced by the simultaneous use of these drugs with nitrates (drugs for the treatment of angina pectoris), alcohol or drugs.
Mental Health Medications: Orthostatic hypotension can be a side effect of tricyclic antidepressants (amitriptyline) and monoamine oxidase inhibitors (phenelzine).
Elderly Age: Orthostatic pressure reduction most often develops in older people. Atherosclerosis, which affects arteries with age, complicates the rapid adaptation of blood vessels to a change in body position. In the elderly, many diseases are associated with a decrease in pressure progress.
Pregnancy: As the gestational age increases, the volume of the circulatory system rises, which may lower blood pressure. So, if you stand up fast, you will be dazzled or feel dizzy. After childbirth, the pressure normalizes.
Alcohol Abuse And Addiction: These are potential risk factors for developing symptoms of orthostatic hypotension.
Postprandial Hypotension: In some people, blood pressure drops after eating. This condition is most often observed in the elderly.(2)
Can Orthostatic Hypotension Be Cured?
The treatment of orthostatic hypotension is complex, with the use of medications and, if necessary, surgical techniques. It is aimed at eliminating the root cause of the pathological condition. This is known as an etiological treatment.
Symptomatic treatment is aimed at stopping the symptoms; it does not play a big role in this case. To relieve the attack, tonic drugs (Citramon, Aspirin, caffeine) are used in dosages strictly verified by the doctor.
A major role is played by a change in the nature of life. You can’t drink alcohol, smoke, you need to eat well and rest normally (sleep at least 8 hours a day, avoid stress), abandon the excessive physical activity. Exhausting yourself in the gyms is not allowed; it is contraindicated and will not add health.(3)(4)
Other Etiological Treatments
Surgery to eliminate atherosclerotic plaques, normalize the state of the heart with congenital and acquired defects, hormone replacement therapy, etc. The technique is selected based on the specific case.
Prevention Of Orthostatic Hypotension Episodes
Simple ways to prevent a decrease in blood pressure when changing body position:
Use More Salt In Your Diet. This can only be done after the advice of a doctor. Too much of it can cause an increase in blood pressure and increase the risk of other diseases.
Eat Smaller Meals. If blood pressure drops after eating, your doctor may recommend eating foods low in carbohydrates and small portions.
Drink Plenty Of Fluids. Maintaining water balance helps prevent a decrease in blood pressure. This advice is especially important for patients with vomiting, diarrhea, or fever.
Limit Or Avoid Drinking Alcohol, as alcohol can worsen orthostatic hypotension.
Specific Physical Exercise Is Good. Before you sit down, do exercises for the calf muscles. Regular exercise can help reduce symptoms of orthostatic hypotension.
Do Not Bend At The Lower Back. If you drop something on the floor, lift them by bending your knees to raise this item.
Wear Compression Hosiery. It helps reduce the amount of blood that builds up in the legs when standing up and alleviates the symptoms of orthostatic hypotension.
Get Up Slowly. You can reduce dizziness and lightheadedness by slowly changing your body position when standing up. Instead of jumping out of bed in the morning, take a deep breath for a few minutes and then sit back slowly. Before you get up, sit on the edge of the bed for at least a couple of minutes.
Raise The Head End Of The Bed. Sleeping in this position can help combat the effects of gravity.(5)
- 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.
- Arnold AC, Raj SR. Orthostatic hypotension: a practical approach to investigation and management. Canadian Journal of Cardiology. 2017;33(12):1725-1728.
- Centi J, Freeman R, Gibbons CH, Neargarder S, Canova AO, Cronin-Golomb A. Effects of orthostatic hypotension on cognition in Parkinson disease. Neurology. 2017;88(1):17-24.
- Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. Journal of neurology. 2017;264(8):1567-1582.
- Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Movement disorders clinical practice. 2017;4(3):298-308.
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