All key facts you ever had read about postural (orthostatic) hypotension

When someone tries to rise up from a laying or sitting position, he may have postural hypotension, which is a dip in blood pressure. Baroreceptors are thought to govern this decline in blood pressure in healthy people by controlling heart rate and vascular resistance. They may not function correctly at times because their effect may be impaired by medicines such as anti-hypertensive drugs.

 

 

Definition

 

 A drop in blood pressure of >20/10mmHg within three (3) minutes after standing from a laying or seated position is known as orthostatic hypotension.

 

Facts about Postural hypotension

 

Its prevalence rises with age, from 5% in younger persons to nearly 30% in the elderly. According to new research, postural hypotension affects about 60% of persons with neurological illnesses like Parkinson's disease.

 

Orthostatic hypotension feeling dizzy

 

 

  Symptoms of orthostatic (postural hypotension)

 

 We shall attempt to list the most prevalent clinical manifestations of this condition, which are as follows:

·      Dizziness

·      Vision is blurry.

·      Light-headedness

·      Lethargy

·      Weakness

·      Nausea/vomiting

·      Heart pounding

·      Headache

For your information, there are a few odd symptoms to mention:

·      Syncope

·      Breathlessness

·      Neck ache

·      Pain in the chest

 

 

 

Causes of the postural hypotension

 

There are a variety of reasons why someone could have the symptoms listed above. We'll aim to recruit a few of them:

Drugs

·      Antidepressants

·      Phenothiazine

·      Sildenafil

·      ACE-inhibitors for controlling blood pressure

·      Levodopa

·      Barbiturates

·      Alcohol

·      Vincristine

·      Diuretics

·      Morphine

 

Conditions affecting your blood pressure as follows:

·      Aortic stenosis

·      Arrhythmias

·      Myocardial infarction

·      Heart failure

·      Anaemia

·      Diabetes Mellitus

·      Hypothyroidism

·      Addison’s disease

·      Vasovagal faints

·      Parkinson’s disease

·      Pregnancy

·      Menstruation

·      Varicose veins

·      Dehydration due to diarrhoea or excessive vomiting

·      Septic, hypovolemic, anaphylactic, and neurogenic shocks are all conditions in which blood pressure drops too low to adequately deliver oxygen to the important organs of the body, such as the kidneys, heart, and brain. Neurogenic shock can occur as a result of a direct impact to the spinal cord or as a result of an intervention, such as spinal anaesthesia, which is uncommon.

 

causes of postural hypotension

   

Investigations to diagnose the condition

 

·      Full blood count

·      Fasting glucose

·      Postprandial glucose within two hours of meal

·      Prothrombin time

·      ECG

·      Echocardiography

·      U/E

·      Tilt –Table testing

·       

The subject is tilted passively at an angle of 60 degrees to 80 degrees for three minutes in this test. Two readings are taken in a laying and inclined position.

If the patient's blood pressure drops, it's a sign that he or she has this disease.

 

Tilt-table testing for postural hypotension

 

Treatment of postural hypotension

 

The goal of treatment is to provide personalised care for the individual and to prevent future injuries.

 Non-pharmacological treatment, such as changing habits and making lifestyle changes, is usually the initial recommendation, which is as follows

·      Light exercises such as toe tapping ,heel lifting, marching at the spot to increase the circulation in the legs and leg extensions

·      Raise the head end of your bed by 15cm or 6 inches.

·      Drugs are reviewed with a senior doctor.

·      Referral to a cardiologist

       *Avoid drinking caffeinated beverages before going to bed, however it is recommended that     

       you drink coffee or take coffee tablets first thing in the morning.

·      Avoid constipation

·      Eat small meals and avoid foods with a lot of sugar.

·      Consume modest, regular meals.

·      Drink as much water as you can, up to two litres.

·      If you are elderly especially, make sure you have some walking aids on hand.

·      Avoid leaning down on your back as much as possible.

·      Request that your doctor examine your bone health. Bone mineral density is important because weak bones are more prone to fractures.

 

   Postural hypotension complication(bone fracture)

 

·      You may use above waist stockings but after medical advice

·      In vasovagal faints, try to avoid trigger like long standing or heated environment or you can try leg crossing or clenching of hips to avoid this happening in future.

 

Pharmacological Treatment

 

·      High sodium intake, which can be obtained by adding salt to your food or by taking sodium tablets followed by fludrocortisone. If you have hypertension, however, you should exercise caution and consult your doctor before using salt tablets. To avoid supine hypertension, the fludrocortisone dose should be administered at least four hours before bedtime.

·      Midodrine, an alpha-receptor agonist, can be used to treat postural hypotension, but it's not recommended if you have heart disease or kidney problems.

·      A somatostatin analogue like octreotide, which blocks the release of peptides from the small intestine to minimise vasodilation caused by peptide release, can also be used to treat this problem.It is taken 30 minutes before meals to help minimise post-prandial hypotension.

·      Noradrenaline proactive drug may also be used to treat orthostatic hypotension.

·      Pyridostigmine is another choice to manage the low blood pressure changed by posture.