Orthostatic Hypotension

(Postural Hypotension)
  • Definition

    Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.
    Measuring of Blood Pressure
    Placement of Blood Pressure Cuff
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  • Causes

    Orthostatic hypotension has several causes.
    • Hypovolemia is the most common cause. It may be due to:
      • Excessive use of loop diuretic medications
      • Vasodilator medications, such as nitrate preparations, calcium channel blockers, or ACE inhibitors
      • Dehydration
      • Prolonged bedrest
      • Addison’s disease with inadequate salt intake
    • Impaired autonomic (nerve) reflex due to certain diseases:
    • Decreased heart muscle contractility or vascular responsiveness
    • Certain drugs:
      • Monoamine oxidase (MAO) inhibitors
      • Tricyclic antidepressants
      • Tetracyclic antidepressants
    • Phenothiazine antipsychotic drugs, such as chlorpromazine, promazine, thioridazine
    • Atypical antipsychotics
    • Quinidine
    • Levodopa
    • Barbiturates
    • Alcohol
  • Risk Factors

    Factors that increase your chance of orthostatic hypotension include:
    • Increased age
    • Use of certain drugs:
      • Loop diuretics
      • Vasodilators
      • MAO inhibitors
      • Tricyclic antidepressants
      • Tetracyclic antidepressants
      • Phenothiazine antipsychotic drugs
      • Quinidine
      • Levodopa
      • Barbiturates
      • Alcohol
    • Inadequate fluid intake
    • Prolonged bedrest
    • Certain diseases or conditions:
      • Atherosclerosis
      • Advanced heart failure
      • Addison’s disease
      • Diabetes
      • Pernicious anemia
      • Amyloidosis
      • Guillain-Barre syndrome
      • Riley-Day syndrome
      • Shy-Drager syndrome
  • Symptoms

    Orthostatic hypotension may cause:
    • Mild to moderate reduction in brain blood flow:
      • Faintness
      • Lightheadedness
      • Weakness
      • Confusion
      • Visual blurring
    • Severe reduction in brain blood flow:
      • Fainting (syncope) or brief loss of consciousness
    Exercise or having eaten a heavy meal may worsen symptoms.
  • Diagnosis

    Orthostatic hypotension is diagnosed when symptoms are present and there is a measured reduction in blood pressure while standing, which is relieved by lying down.
  • Treatment

    Treatment for orthostatic hypotension depends on the cause.
    Treatments include:
    Adjusting Dosage or Type of Medication
    When orthostatic hypotension is due to hypovolemia related to medications, adjusting or stopping medication may be needed to reverse the condition.
    Treating Dehydration
    Orthostatic hypotension resulting from dehydration is treated with fluids and electrolyte replacement.
    Minimizing Bedrest
    If bedrest is the cause of orthostatic hypotension, symptoms may be improved by increasing time spent sitting up in bed.
    Medications
    A number of medications may be given to boost blood pressure. Over-the-counter medications include caffeine and ibuprofen.
    Other Interventions
    In some cases, individuals may be encouraged to increase their intake of salt. Fitted elastic stockings that go up to the waist may be worn. Individuals may need to be taught to rise from lying down, to sit up, and to stand in a slow and gradual manner. Similarly, they should be discouraged from standing still for too long a time.
  • Prevention

    There is no way to prevent orthostatic hypotension if it is a result of other diseases or conditions. However, if your orthostatic hypotension relates to medications, dehydration, or bedrest, you should talk with your healthcare provider about treatment options.
  • RESOURCES

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    National Organization for Rare Disorders http://www.rarediseases.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Heart and Stroke Foundation http://www.heartandstroke.ca

    References

    Berkow R, Beers MH, Fletcher AJ, eds. The Merck Manual of Medical Information—Home Edition. 2nd ed. Simon and Schuster, Inc; 2003.

    Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 8th ed. St. Louis, MO: Mosby; 2006.

    Goldman L. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: Saunders; 2004.

    Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007;120:841-847. Review.

    Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005;366:665-675.

    NINDS orthostatic hypotension information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/orthostatic%5Fhypotension/orthostatic%5Fhypotension.htm. Updated September 30, 2011. Accessed August 21, 2014.

    Orthostatic syncope. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 25, 2014. Accessed August 21, 2014.

    Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120:975-980.

    Revision Information

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