Orthostatic Hypotension (Postural Hypotension)

Are you suffering from dizziness or lightheadedness whenever you stand up? Do you faint occasionally? If yes, then you might be having a chronic blood pressure disorder known as Postural Hypotension. Find out all about the disease and get detailed information about its causes, symptoms, diagnosis and treatment.

Orthostatic Hypotension Definition

It is defined as a type of hypotension (low blood pressure) in which the systolic blood pressure reduces to 20mmHg or more when a person is standing up or stretching. It is generally mild in nature. However, long lasting hypotension postural can give rise to very serious health issues.

This disease is related with conditions like:

• Diabetes
• Addison’s disease
• Autonomic system neuropathies
• Multiple System Atrophy with Orthostatic Hypotension (and other forms of Dysautonomia)

Orthostatic Hypotension ICD9 Code

The ICD9 code for this clinical condition is 458.0.

Orthostatic Hypotension Synonyms

This ailment is also referred to as Postural hypotension. In colloquial language, this disorder is known as dizzy spell or head rush.

Orthostatic Hypotension Incidence

This form of hypotension is more common when there is any kind of injury. An individual is more prone to Orthostatic hypotension if the injury level is at T-6 or more than that. Individuals affected with spinal cord injury can also experience this blood pressure syndrome. Though it can affect anyone, the occurrence of postural orthostatic hypotension increases with age and is prevalent among the elderly.

Orthostatic hypotension is more frequent among the people who take drugs to administer high blood pressure or suffering from autonomic nervous system dysfunction diabetes and atherosclerosis. In a few cases, it also occurs during pregnancy,

Causes of Orthostatic Hypotension

According to human anatomy when you stand up, blood collects in your legs due to the gravitational force. This minimizes the blood pressure level since the blood flowing back to the heart is less. This form of hypotention arises when the normal method of sabotaging low blood pressure is disturbed. Few other reasons which give rise to this chronic blood pressure syndrome include:

Heart problems

A few heart disorders can lower the blood pressure level comprise of heart valve problems, heart valve problems, heart failure and heart attack. Such medical conditions can give rise to orthostatic hypotension, since they restrict the ability of the body to respond quickly to pump adequate blood when required, especially when standing up.

Nervous System Ailments

Certain nervous disorders can disturb the blood pressure system. These include multiple system atrophy (Shy-Drager peripheral neuropathies), Parkinson’s disease and amyloidosis.

Dehydration

The body loses volume during dehydration and leads to low blood pressure. Few conditions which can cause dehydration may include fever, inadequate consumption of fluids, vomiting, diarrhea and arduous exercise along with profuse sweating. Due to loss of blood, even mild type of Orthostatic hypotension can lead to the occurrence of its symptoms.

Diabetes

If diabetes is left untreated, it can cause frequent urination and give rise to dehydration. Severe dehydration can trigger hypotension postural in the body of sufferers.

Symptoms of Orthostatic Hypotension

Orthostatic Hypotension is characterized by lightheadedness or dizziness occurring during change in body posture such as lying down or sitting up. The symptoms which confirm the occurrence of this blood pressure disorder may include:

• Mental confusion
• Bodily dislocation
• Muscle tremors
• Nausea
• Numbness
• Severe or general tingling or fainting
• Dizziness
• Hearing deformation
• Headache
• Pain adjacent to the shoulders and neck
• Euphoria
• Vasovagal syncope in rare cases
• Lightheadedness
• Momentary blindness or dimmed vision

Due to inadequate blood pressure and insufficient blood supply (cerebral perfusion), patients can experience severe outcomes and often complain about a strange warm feeling around the shoulder and head areas after the dizziness goes away.

Diagnosis of Orthostatic Hypotension

The main objective in determining orthostatic hypotension is to find out the underlying cause of its origin. The exact reason of the occurrence will help to evaluate the appropriate treatment for its cure and find out if nervous system, heart or brain problems are causing the blood pressure level to deteriorate. Doctors recommend a number of clinical procedures and tests to determine the existence of Orthostatic hypotension including:

ECG

Electrocardiogram is a noninvasive test which identifies the abnormalities inside the heart along with issues related with oxygen and blood supply to the heart muscle.

Stress Test

Some heart related problems which give rise to low blood pressure are much easy to diagnose when the heart is at work rather than when it is at rest. During exercise, such as while walking on a treadmill, the heart works much faster than normal. In a few cases, medicines are recommended to make the heart work harder for patients who are incapable of performing any exercise. When the heart is working harder and faster, echocardiography or electrocardiography is used to administer it along with the blood pressure level.

Tilt table test

This diagnostic procedure helps to determine how individual body responds to certain changes in position and the changes in the blood pressure level.

Blood Pressure Monitoring

Doctors analyze the difference of blood pressure level when a patient is standing up and sitting down. Doctors diagnose orthostatic hypotension if there is a drop in 20 millimeters of mercury in the systolic blood pressure or 10mm Hg drop in the diastolic pressure.

Valsalva maneuver

It is noninvasive diagnostic procedure which detects the operation of the autonomic nervous system by evaluating the heart rate and blood pressure level after continuous periods of deep breathing.

Blood tests

This procedure helps to determine the overall condition of the health and detects the existence of hypoglycemia or anemia in the body which can lead to low blood pressure levels.

Ambulatory blood pressure and ECG recording

This procedure comprises of blood pressure cuffs for a span of 24 hours which will record the blood pressure fluctuations. A monitor will be attached to enable constant ECG reading.

Orthostatic Hypotension Management

Orthostatic hypotension can be managed by each and every patient. It can be done by simply following the guidelines of respective doctors and taking little precautions. Some suggestions recommended by doctors may include:

• Standing up slowly will enable the blood vessels to contract in a better manner and avoid syncope (fainting)
• By loosening the abdominal muscles and taking deep breaths while rising assists in maintaining a constant oxygen and blood flow to the brain.
• Eating smaller meals throughout the day can help the blood pressure from lowering.
• Avoiding certain body postures such as sitting with knees up to chest which obstruct regular flow of blood and give rise to incidents.
• Extra care should be taken if one attempts to stand after eating.
• When such form of hypotension is caused by hypoyolemia because of certain medicines, the process can be reversed by changing the medicine dose or changing it completely.

Treatment of Orthostatic Hypotension

The treatment for Postural Hypotension is based on its cause. If orthostatic hypotension is mild in nature, the treatment for such type is to lie down or sit when lightheaded felling occurs due to standing. Doctors first try to detect the underlying health problems which include:

• Heart failure
• Dehydration
• Low blood pressure level

Doctors and physicians recommend different types of medications and treating options to cure this form of hypotension including:

Compression stockings

Leotards and elastic stockings are utilized to reduce the pain and heal the swelling of the varicose veins. These help to reduce the warning signs of orthostatic hypotension by minimizing the accumulation of blood in the legs.

Lifestyle Changes

Another effective option for treating this syndrome is by drinking enough fluids (water) and any form of alcohol. Doctors suggest orthostatic hypotension patients to stand up slowly and avoid walking in hot climate. Exercise programs to stiffen the calf muscles and increasing salt in the diet are also recommended by physicians for orthostatic hypotension patients.

Medications

Few medications which are recommended by doctors for the treatment of orthostatic hypotension may include:

• Fludrocortisone
• Midodrine
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Caffeine and epoetin (Epogen, Procrit)
• Pyridostigmine (Mestinon)

Orthostatic Hypotension Prognosis

Orthostatic hypotension may give rise to accidental falls. The prognosis for such patients solely depends on the cause of the syndrome.

Orthostatic Hypotension Prevention

Doctors recommend a few procedures and techniques for the prevention of Orthostatic hypotension. Following the prevention methods would help patients to deal with the complications and problems arising due to this syndrome. Such measures include:

• Avoid bending of the waist and squat your knees to pick up something from the floor.
• Sleeping in an elevating position
• Trying to move slowly from a sitting to standing position.

Orthostatic Hypotension Complications

Mild orthostatic hypotension is a minor irritant whereas the severe form is much more complicated and is present especially in adults. However, a few other additional complications include:

Stroke

Due to reduced supply of blood to the brain, patients are more prone to stroke.

Falls

Patients affected with orthostatic hypotension often experience syncope (fainting) and fall down frequently.

Orthostatic Hypotension Risk Factors

The risk factors for the disease include:

Age

This disorder is more common among the people who are aged 65 and above. Due to aging, baroreceptors cells become incapable to monitor the blood pressure level. Consequently, the heart cannot beat faster and hence blood pressure drops.

Diseases

A few disorders such as Parkinson’s disease along with other heart conditions make a patient more vulnerable to low blood pressure.

Medicines

Individuals who take high blood pressure medicines are more prone to orthostatic hypotension. Such medicines include water pills, beta blockers, tricyclic antidepressants, sildenafi etc.

Exposure to heat

If an individual is exposed to any hot and humid climate, he/she can get dehydrated and give rise to low blood pressure which can trigger orthostatic hypotension.

If you or any of your family member is experiencing the symptoms of Orthostatic hypotension, consult your family physician immediately. Do not neglect the disorder, for it can give rise to a number of severe complications in the body.

References:

http://jnnp.bmj.com/content/65/3/285.full

http://www.ninds.nih.gov/disorders/orthostatic_hypotension/orthostatic_hypotension.htm

http://en.wikipedia.org/wiki/Orthostatic_hypotension

http://calder.med.miami.edu/pointis/pos.html