What is Orthostatic Hypotension?
Orthostatic Hypotension (OH) is a condition where blood pressure drops significantly upon standing up, leading to dizziness, lightheadedness, or fainting. It is often linked to dysfunction in the autonomic nervous system, dehydration, or underlying medical conditions.
OH can be classified into different types:
- Neurogenic OH: Caused by disorders affecting the autonomic nervous system, such as Parkinson’s disease.
- Non-Neurogenic OH: Occurs due to dehydration, blood loss, or medication side effects.
- Initial OH: A brief drop in blood pressure immediately after standing, lasting only a few seconds.
- Delayed OH: Blood pressure drops gradually after standing for several minutes.
Causes and Risk Factors
OH can result from various underlying issues or lifestyle factors. Common causes include:
- Dehydration: Low fluid levels reduce blood volume and circulation.
- Blood Loss or Anemia: Affects the ability of the blood to carry oxygen efficiently.
- Autonomic Nervous System Disorders: Conditions like Parkinson’s disease and multiple system atrophy impair blood pressure regulation.
- Heart Conditions: Congestive heart failure and arrhythmias can affect blood circulation.
- Medications: Diuretics, antidepressants, and antihypertensive drugs can contribute to OH.
- Prolonged Bed Rest: Leads to deconditioning and poor blood circulation regulation.
- Diabetes: Nerve damage from long-term diabetes can affect blood pressure control.
Symptoms of Orthostatic Hypotension
OH symptoms typically appear upon standing and may include:
- Dizziness or Lightheadedness: Sudden blood pressure drop affects brain oxygen supply.
- Fainting (Syncope): Severe cases may result in blackouts.
- Blurred Vision: Reduced blood flow to the eyes may cause visual disturbances.
- Nausea: Some individuals feel sick or unsteady upon standing.
- Weakness: Reduced blood flow can cause temporary muscle weakness.
Severe or frequent episodes may require medical attention to prevent complications.
Diagnosis of Orthostatic Hypotension
OH is diagnosed through tests that assess blood pressure response upon standing:
- Blood Pressure Measurement: Readings taken while lying, sitting, and standing.
- Tilt Table Test: Evaluates blood pressure and heart rate changes in controlled conditions.
- Electrocardiogram (ECG): Checks for underlying heart issues.
- Blood Tests: Assess anemia, dehydration, and metabolic disorders.
- Autonomic Testing: Measures nervous system response to position changes.
Treatment and Management
OH management focuses on preventing symptoms and improving blood circulation. Treatment options include:
- Medications:
- Fludrocortisone: Increases blood volume.
- Midodrine: Helps constrict blood vessels to maintain blood pressure.
- Droxidopa: Assists with autonomic dysfunction-related hypotension.
- Lifestyle Modifications:
- Increase fluid and salt intake to stabilize blood pressure.
- Wear compression stockings to prevent blood pooling in the legs.
- Rise slowly from sitting or lying positions to allow blood pressure adjustment.
- Avoid prolonged standing and extreme heat exposure.
- Exercise regularly to improve circulation and cardiovascular health.
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