Orthostatic Hypotension (low blood pressure from changing posture) is a condition in which blood pressure in the body drops suddenly from a sudden change in posture. It occurs when changing posture to stand up quickly from a sitting or lying position because less blood in the body flows back to the heart. This results in abnormal symptoms in the body such as dizziness, faintness, or fainting.
Orthostatic Hypotension is a type of low blood pressure that can be caused by many factors, but the elderly may be at higher risk of developing this condition, especially those aged 65 and over. However, most symptoms are usually mild and only temporary. However, those who experience this condition frequently may be a sign of a serious disease or physical abnormality. Therefore, patients should observe their symptoms and see a doctor for proper diagnosis and treatment if the symptoms become severe.
Symptoms of Orthostatic Hypotension
People with orthostatic hypotension often experience dizziness or lightheadedness when changing from a sitting or lying position to a standing position. The symptoms are usually temporary, especially in the morning, during times of dehydration, when blood sugar levels are low, or when the environment or body temperature is high. The symptoms then gradually improve.
In some cases, patients may experience other symptoms such as blurred vision, fatigue, nausea, headache, shortness of breath, difficulty concentrating, confusion, feeling hot, sweating, palpitations, muscle tremors, or fainting.
Most of the symptoms of Orthostatic Hypotension are not serious. However, those who experience frequent symptoms or other abnormalities such as chest pain, collapse, loss of consciousness, or shock , which may cause pale or cold skin, excessive sweating, rapid breathing, or low pulse, should see a doctor for proper diagnosis and treatment.
Causes of Orthostatic Hypotension
Normally, blood pressure when standing up will be lower because the heart has less blood flowing back than normal. This is because when changing from sitting or lying down to standing, more blood in the body flows to the abdomen and legs due to gravity. The body will adjust the blood pressure back to normal by stimulating the heart to beat faster to pump blood and constrict the blood vessels in the abdomen and legs.
However, people with Orthostatic Hypotension will find that the above blood pressure regulation mechanisms do not work properly. This may occur for unknown reasons or there may be some related factors such as:
- As we age, especially in the age of 65 years and above, our body’s ability to regulate blood pressure decreases.
- Heart disorders such as bradycardia, ischemia, heart attack, etc.
- Neurological disorders such as Parkinson’s Disease or Lewy Body Dementia.
- Certain diseases or conditions, such as thyroid disorders, Addison ‘s Disease , diabetes, low blood sugar, dehydration, or anemia, etc.
- Use of certain medications, such as high blood pressure medications, heart medications, Parkinson’s medications, antipsychotics, muscle relaxants, erectile dysfunction medications, antidepressants, or narcotics.
Orthostatic Hypotension may also be related to other factors such as diet, as more blood flows to the intestinal tract during digestion, pregnancy, especially during the first 24 weeks of pregnancy, vitamin B12 deficiency, significant blood loss, lying in bed for long periods of time, drinking large amounts of alcoholic beverages, or being in an environment that is too hot.
Diagnosis of Orthostatic Hypotension
The doctor will ask about the patient’s symptoms and medical history, such as chronic diseases or drug use history, along with a preliminary physical examination. If the doctor sees that the patient has a tendency to have Orthostatic Hypotension, the doctor will measure the patient’s blood pressure while standing, sitting or lying down. The doctor will diagnose the patient with Orthostatic Hypotension if the following criteria are met:
- Systolic blood pressure (BBP) decreases by 20 mmHg after standing for approximately 2–5 minutes.
- Diastolic blood pressure (BBP) decreases by 10 mmHg after standing for approximately 2–5 minutes.
- The patient experiences abnormal symptoms consistent with this condition while standing up.
Then, if the doctor diagnoses the patient with Orthostatic Hypotension, the doctor may perform additional tests based on each person’s risk factors to find the cause and use the results to consider the appropriate treatment method for each patient, such as blood tests, using an adjustable bed with blood pressure measurement (Tilt Table Test), an electrocardiogram (EKG) or an echocardiogram, etc.
Treatment of Orthostatic Hypotension
Doctors will consider the treatment method for each patient based on the cause, such as surgery or certain medications for heart patients, increasing the amount of water consumed if the patient is dehydrated, adjusting the amount of certain medications that may be the cause, wearing medical stockings or abdominal compression devices to reduce the amount of blood flow in the legs, etc.
If a patient has severe orthostatic hypotension, the doctor may also use certain medications to increase blood levels in the body or constrict blood vessels, such as fludrocortisone, midodrine, or erythropoietin .
In addition, doctors may recommend that patients change certain behaviors in conjunction with medical treatment, such as avoiding standing up quickly from a sitting or lying position, avoiding being in hot places, avoiding sitting and crossing their legs, avoiding eating foods high in carbohydrates, or in cases where patients do not have high blood pressure, doctors may recommend that patients increase the amount of salt they eat in each menu item to maintain water levels in the body.
Complications of Orthostatic Hypotension
People with chronic and untreated orthostatic hypotension, especially the elderly, are at risk of accidents or injuries from fainting, such as falls, broken bones, or brain injuries.
In addition, patients may be at risk of developing other serious diseases or conditions such as cerebrovascular disease from insufficient blood flow to the brain, shock or organ failure from low blood pressure, or cardiovascular diseases such as heart attack and arrhythmia.
Prevention of Orthostatic Hypotension
Since Orthostatic Hypotension is a condition that can be caused by many factors, prevention may be difficult. However, the initial risk can be reduced by following these methods:
- Drink enough water to meet your body’s needs, but avoid alcoholic and caffeinated drinks.
- Control the amount of high-carbohydrate foods you eat at each meal to an appropriate amount.
- Avoid being in high temperature environments.
- Adjust the pillow to support your head when sleeping.
- Avoid standing up quickly while sitting or lying down.
- Move or change positions frequently if you have to stand or stay in the same position for long periods of time.
