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Orthostatic Hypotension

Your body has a network of blood vessels made up of arteries, veins, and capillaries. The heart pumps blood into the arteries, which carry the blood throughout the body. Blood pressure is the pressure or force of blood pushing against the walls of the arteries.

Orthostatic hypotension is a condition in which your blood pressure falls significantly when you stand up quickly. (Hypotension is low blood pressure.)

Blood pressure is written as two numbers; for example, 120 over 80 millimeters of mercury. The first number is the systolic pressure. This is the pressure in the arteries when the heart beats and fills them with blood. The second number is the diastolic pressure. This is the pressure in the arteries when the heart rests between beats.

What are the symptoms of orthostatic hypotension?

The main symptom of orthostatic hypotension is feeling dizzy or lightheaded when you stand up. In some cases, people with orthostatic hypotension may even faint.

Other symptoms include:

  • blurred vision
  • nausea
  • disorientation or confusion
  • feeling weak
  • fatigue
  • falling
  • chest pain

These symptoms usually clear up when you sit or lie down for a few minutes.

What are the causes of orthostatic hypotension?

The causes of orthostatic hypotension include the following:

  • aging (orthostatic hypotension is more common in older people)
  • hypovolemia (a drop in the volume of blood). Hypovolemia can be caused by bleeding, elevated sugar, or medications like diuretics, such as thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide).
  • dehydration (low fluid volume in the body)
  • immobility (for instance, staying in bed for a long time)
  • pregnancy
  • heart conditions, including heart attack, heart failure, irregular heart rhythm, and valve disease
  • anemia (low red blood cell count)
  • Parkinson's disease
  • diseases of the endocrine system, including diabetes, adrenal insufficiency, and thyroid conditions
  • medications used to treat elevated blood pressure, such as beta blockers, calcium channel blockers, ACE inhibitors, nitrates, and angiotensin II blockers. Patients who are susceptible to this are those with conditions listed above (e.g., diabetes, Parkinson's).
  • other medications for anxiety, depression, erectile dysfunction, or Parkinson's disease
  • substances that are taken at the same time as blood pressure medications, such as alcohol, barbiturates, and other medications
  • hot weather

How is orthostatic hypotension diagnosed?

If your doctor thinks you may have orthostatic hypotension, he or she will check your blood pressure in lying, sitting, and upright positions. The doctor will also conduct a physical examination in order to find a medical condition that may be causing the hypotension.

The doctor may also order certain tests, including the following:

  • blood test (to check for anemia or diabetes)
  • electrocardiogram, or EKG (to check your heart's rhythm)
  • Holter monitor (a portable device that you wear to check your heart's rhythm over a period of time)
  • echocardiogram (ultrasound examination of the heart)
  • stress test, in which the doctor monitors your heart rate while you are exercising
  • Valsalva maneuver, in which you take several deep breaths while your doctor checks your blood pressure and heart rate
  • tilt table test. You might have this test if you are prone to fainting. You lie on a table that is moved from a horizontal to an upright position. Your doctor will want to know if you faint during this test.

How is orthostatic hypotension treated?

If you have episodes of orthostatic hypotension, your doctor will first try to determine if you have another condition or disease that is causing it. In many cases, treating the disease that is causing the orthostatic hypotension will cure it.

If a certain medication is causing the orthostatic hypotension, your doctor may adjust the dosage or switch you to another medication.

One method of treating orthostatic hypotension is to make some changes in your daily life. These can include the following:

  • If you are dehydrated, drink more fluids.
  • Limit or avoid alcohol (alcohol causes dehydration).
  • Stand up slowly when getting out of a chair.
  • Don't cross your legs when you are sitting.
  • If you have to stay in bed for medical reasons, try sitting up for short periods of time.
  • When you are getting out of bed, get up slowly and sit on the edge of your bed for several minutes before you stand up.
  • You may perform isometric exercises (such as squeezing a rubber ball or a towel for a few minutes) before assuming an upright position. These exercises will raise your blood pressure and may prevent a significant drop in blood pressure when you stand up.
  • You can wear compression stockings, which apply pressure to your legs and help with blood circulation.
  • Raise the head of your bed.
  • Avoid prolonged standing.

Your doctor may prescribe a medication to treat the orthostatic hypotension, such as fludrocortisone (Florinef®), midodrine (ProAmatine®), or erythropoietin (Epogen®, Procrit®). These drugs work by increasing blood volume or by constricting (narrowing) blood vessels.

What is the outlook for people with orthostatic hypotension?

Orthostatic hypotension can be treated successfully. If you have episodes of this condition, you can seek treatment and live a normal life.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/19/2013…#9385


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