Orthostatic hypotension (OH) is a condition that affects blood pressure when an individual changes position from a sitting or lying to a standing position. It is a common condition that affects approximately 20% of individuals above the age of 65 years.

OH is characterized by a fall in systolic blood pressure of at least 20 mm Hg or diastolic pressure of at least 10 mm Hg within three minutes of standing.

Causes of Orthostatic Hypotension

OH may occur as a result of several causes including dehydration, blood loss, heart failure, and medication effects. Dehydration as a result of water deficiency can lead to a reduced blood volume which can cause a decrease in blood pressure.

Medications such as diuretics, antihypertensive, antidepressants, and antipsychotic drugs can interfere with the autonomic nervous system which is responsible for regulating blood pressure. Inadequate blood volume due to blood loss during surgery or trauma can also cause OH, and heart failure may also result in OH.

Symptoms of Orthostatic Hypotension

The most common symptom of OH is lightheadedness, but other symptoms include blurred vision, weakness, fainting, fatigue, and confusion. OH may not cause any symptoms in some individuals, especially those with mild symptoms.

In severe cases, OH can lead to falls and injuries, and its complications may limit the daily activities of affected individuals.

Diagnosis of Orthostatic Hypotension

OH diagnosis may involve taking a patient’s medical history and a physical examination that include checking for changes in blood pressure when in a standing or sitting position.

A tilt table test may also be performed to measure blood pressure and heart rate changes from lying to standing positions. The test involves strapping the patient on a table that can be tilted to different angles to mimic standing while monitoring the patient’s vital signs. Blood tests may be carried out to identify the underlying cause of OH.

Treatment of Orthostatic Hypotension

The treatment of OH depends on its underlying cause. For example, treatment of dehydration may involve fluids and electrolyte replacement. In cases where medication is causing OH, a change of medication or reducing the dosage may be recommended.

Compression stockings may also be recommended to reduce pooling of blood in the legs. OH treatment may also involve lifestyle changes such as increasing salt and fluid intake, avoiding sudden changes in position, and physical therapy.

Association with Cardiovascular Disease

OH has been associated with an increased risk of cardiovascular disease (CVD). The risk of ischemic heart disease and stroke is higher in individuals with OH compared to those without.

OH may also be an early sign of autonomic dysfunction which is known to be a risk factor for CVD. OH may be a useful marker for identifying individuals at risk of CVD, especially in older adults.

Prevention and Management

The prevention and management of OH involve identifying and treating its underlying cause. For example, preventing dehydration by ensuring adequate fluid intake is essential in managing OH.

Physicians should carefully monitor patients who are taking medications that may cause OH and adjust the dosage appropriately. OH patients should avoid sudden changes in position and engage in leg exercises such as ankle pumps before standing. Patients should also wear compression stockings to improve blood flow and prevent blood pooling in the legs.

Conclusion

OH is a common condition characterized by a decrease in blood pressure when changing position from lying to standing. It may be caused by dehydration, blood loss, heart failure, and medication effects.

OH may be asymptomatic or present with symptoms such as lightheadedness, weakness, and fainting. OH has been associated with an increased risk of CVD, and its management involves identifying and treating its underlying cause.