What is Postural Hypotension & How is it Treated?

Postural Hypotension which is also known by the name of Orthostatic Hypotension is a pathological condition in which the individual suffering from it tends to have low blood pressure when going up to a standing position from sitting or lying down. The main symptom of Postural Hypotension is dizziness or a feeling of being lightheaded. In some cases, the individual may even pass out due to the dip in blood pressure.

Postural Hypotension is generally mild and the symptoms just last for a few seconds to a minute or so, although persistent Postural Hypotension may be a sign of a serious underlying issue that may require treatment and requires consultation with a physician. This is more so if the individual frequently passes out when changing positions like getting up from a seated or lying down positions even though the passing out spell may be just for a few seconds.

Mild cases of Postural Hypotension do not require treatment but severe cases of this condition require treatment and the treatment for it depends on the underlying cause of the condition.

When it comes to the cause of Postural Hypotension, when an individual stands as a result of gravitational force the blood starts to pool in the individual’s legs and because of that there is less blood that goes to the heart resulting in a drop in blood pressure.

Under normal circumstances, there are cells near the heart and neck arteries which send a signal to the brain which in turn sends signals to the heart to beat faster so that more blood can be pumped and the blood pressure can be normalized. Another function of these cells are to narrow down the arteries so that the blood passes through the arteries slowly thus increasing the blood pressure. When these cells somehow malfunction or do not send the signal to the brain then the whole system of normalizing the blood pressure by the body does not function appropriately and the blood pressure dips down further. This is what results in symptoms and this condition is what is called as Postural Hypotension.

There are also certain medical conditions that can cause Postural Hypotension. These conditions are:

• Dehydration
• Fever
• Bouts of vomiting
• Inadequate intake of fluids
• Severe diarrhea
• Strenuous exercise
• Certain heart conditions
• Certain endocrine problems like thyroid disorders, adrenal insufficiency, hypoglycemia, diabetes
• Nervous system disorders like Parkinson’s disease, multisystem atrophy, amyloidosis.

The classic presenting symptom of Postural Hypotension is dizziness and lightheadedness upon changing positions. This sensation may happen immediately after standing up from a sitting or lying down position and may last a few seconds. Some of the other symptoms of Postural Hypotension are:

• Blurry vision
• Weakness
• Syncope
• Confusion
• Nausea.

The cause of Postural Hypotension is also as important to diagnose as the diagnosis of Postural Hypotension. When a patient presents with the above described symptoms, the first thing the doctor will do is to take down a detailed history of the patient in order to find out if there are any condition that the patient may have which can cause such symptoms. Additionally, the blood pressure of the patient will be checked in various positions like when the patient is sitting, standing, or lying down. The difference in blood pressure will be monitored. If there is a significant drop in blood pressure from a sitting down position to a standing position then a diagnosis of Postural Hypotension becomes obvious and confirmed. The difference should be about 20 mmHg systolic and 10 mmHg diastolic within five minutes of taking the blood pressure. A blood test will also be taken to look for any signs of diabetes or low blood sugar as a cause for Postural Hypotension. The blood tests can also confirm the presence of anemia which may also cause a drop in blood pressure. The patient may also have to undergo an ECG to look at the functioning of the heart and see if any abnormality in the functioning of the heart may be causing Postural Hypotension.

As stated above, the treatment for Postural Hypotension is dependent on the underlying cause. The treating physician will prefer to first identify the cause of the blood pressure drop and treat that before treating the low blood pressure itself. Mild cases of Postural Hypotension do not require treatment and the patient may just sit back down or lie down when feeling dizzy after getting up. This will resolve the symptoms.

Postural Hypotension caused by medications may be treated by adjusting the dose of the medication or by replacing the medication with some other form of medication which does not cause Postural Hypotension.

Apart from this, the doctor may suggest making some lifestyle changes like eating regular meals, drinking adequate quantity of water especially in the summer months to prevent dehydration which is one of the principal causes of Postural Hypotension.

The patient will also be recommended to abstain from any alcoholic beverages. Additionally, it will be recommended that the patient elevate the head of the bed or use more than one pillow for sleeping. If the patient is not at risk for hypertension then it might be recommended to increase salt in the diet to increase the blood pressure.

In some cases compression stockings have been found to be effective in preventing pooling of blood in the legs when standing and thus preventing Postural Hypotension.

There are also certain medications that can be used for Postural Hypotension like fludrocortisone or midodrine which have been quite effective in treating Postural Hypotension.

There are also certain home remedies or lifestyle changes which can be tried to get rid of Postural Hypotension. These methods are:

• Salt Usage: If you are not at risk for hypertension, you may increase the salt in the diet but this should be done with caution and only at the advice of the treating physician.
• Healthy Diet: Maintain a healthy diet and try and eat two to three small meals a day and drink plenty of water.
• Exercise: Try and exercise the calf muscle before standing up as this helps quite a bit in preventing Postural Hypotension.