Omar Bennett
Orthostasis, from the Greek orthos (upright) and histanai (to stand), is a physiological response of the sympathetic system to counteract a fall in blood pressure when a person moves from a laying down to a standing position. Orthostatic hypotension is characterised by a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing. It can be acute or chronic, symptomatic or asymptomatic, and may lead to dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headaches. The condition becomes more common with age, with 20% of patients over 65 years old experiencing it, and it is associated with an increased risk of cardiovascular disease and all-cause mortality in those aged 55 and above.
| Characteristics | Values |
|---|---|
| Decrease in systolic blood pressure | ≥20 mm Hg |
| Decrease in diastolic blood pressure | ≥10 mm Hg |
| Time taken for the above changes to occur | Within 3 minutes of standing or a head-up tilt table at 60⁰ |
| Age group | Commonly observed in patients older than 65 years, increasing with age |
| Symptoms | Dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, headache, syncope, dyspnea, chest pain, neck and shoulder pain |
| Risk Factors | Dehydration, blood loss, disorders of the neurologic, cardiovascular or endocrine systems, medication |
| Treatment | Eliminate predisposing factors, especially medications, exclude hypovolemic status, non-pharmacological maneuvers, pharmacological interventions |
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What You'll Learn
- Orthostatic hypotension is a drop in blood pressure when moving from lying down to standing
- It is defined as a decrease in systolic BP of 20 mm Hg or diastolic BP of 10 mm Hg within 3 minutes of standing
- It can be acute or chronic, symptomatic or asymptomatic
- Symptoms include dizziness, blurred vision, weakness, fatigue, nausea, and headache
- Causes include dehydration, blood loss, and neurological, cardiovascular, or endocrine disorders
Orthostatic hypotension is a drop in blood pressure when moving from lying down to standing
Orthostatic hypotension, also known as postural hypotension, is a condition characterised by a sudden drop in blood pressure when moving from a lying down or seated position to a standing position. It is caused by the effects of gravity on the body's blood flow, specifically the movement of blood from the upper body to the lower limbs when standing up. This results in a temporary reduction in the amount of blood available for the heart to pump, leading to decreased blood pressure.
The condition is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing. It can cause a range of symptoms, including dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. Less common symptoms include syncope (fainting), dyspnea, chest pain, and neck and shoulder pain. Orthostatic hypotension can be acute or chronic, symptomatic or asymptomatic, and may be caused by various factors, including dehydration, blood loss, neurologic disorders, cardiovascular issues, endocrine system disorders, and certain medications.
The diagnosis of orthostatic hypotension involves taking a detailed medical history and performing physical examinations, including blood pressure measurements in different positions. The tilt-table test is a specific procedure used to evaluate orthostatic hypotension by measuring blood pressure, heart rate, and heart rhythm while the patient moves from a horizontal to a vertical position. Treatment options may include changing medication, increasing fluid and salt intake, wearing elastic stockings, and in rare cases, medications to increase blood volume and pressure.
The non-neurogenic form of orthostatic hypotension is often caused by environmental or health factors that impair the body's ability to stabilise blood pressure upon standing, such as heart disease, low blood volume, alcohol use, or advanced age. On the other hand, the neurogenic form is caused by problems with the autonomic nervous system, which controls involuntary body functions, including blood pressure regulation. Disorders affecting this system can impair the body's ability to adjust blood pressure, leading to orthostatic hypotension. These disorders often have a strong genetic component and may affect multiple family members.
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It is defined as a decrease in systolic BP of 20 mm Hg or diastolic BP of 10 mm Hg within 3 minutes of standing
Orthostatic hypotension, or orthostasis, is a physiological response of the sympathetic system to a change in body position from lying down to standing up. The word "orthostasis" comes from the Greek "orthos" (meaning upright) and "histanai" (meaning to stand). When an individual stands, the force of gravity causes a shift of around 500 to 800 mL of blood from the upper body to the lower body and the splanchnic circulation. This results in a temporary reduction in cardiac output and a decrease in blood pressure.
In most cases, the body can quickly adjust to this change and maintain stable blood pressure and blood flow. However, in some individuals, this compensatory response may be inadequate, leading to orthostatic hypotension. Orthostatic hypotension is specifically defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing, compared to blood pressure in the sitting or supine position. This condition can be acute or chronic and may be symptomatic or asymptomatic.
Symptoms of orthostatic hypotension are a result of transient insufficient perfusion to organ tissue, most commonly affecting the brain. Common symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headaches. Less common symptoms include syncope, dyspnea, chest pain, and neck and shoulder pain. These symptoms can be aggravated by factors such as heavy meals, hot weather, or early mornings. In severe cases, orthostatic hypotension can lead to falls and injuries, especially in older adults.
The evaluation and management of orthostatic hypotension involve a multidisciplinary approach. The first step is to identify reversible causes, such as dehydration, blood loss, or medication side effects, and address them. This may include adjusting medication doses or switching to alternative drugs. Lifestyle changes, such as increasing fluid and salt intake, wearing elastic stockings, and performing specific exercises, can also help manage orthostatic hypotension. In some cases, medication may be required to increase blood volume and pressure. It is important to monitor patients for potential adverse effects, such as syncope and arrhythmias, during the diagnostic process and treatment.
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It can be acute or chronic, symptomatic or asymptomatic
Orthostatic hypotension (OH) is a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. It can be acute or chronic, symptomatic or asymptomatic.
When a person stands up, gravity causes a shift of 500 to 800 mL of blood volume from the upper body to the lower body and the splanchnic circulation. This is a normal physiological response of the sympathetic system to counteract a fall in blood pressure when a person is laying down and assumes the upright position. This compensatory response of the autonomic nervous system is an evolutionary adaptation unique to humans.
Orthostatic hypotension occurs when the body cannot effectively counteract this force of gravity and maintain stable blood pressure and blood flow. This results in a prolonged drop in blood pressure. While this transient orthostatic hypotension often goes unnoticed, it can cause lightheadedness that may result in falls and injury, especially in older adults.
Orthostatic hypotension can be acute or chronic. Acute orthostatic hypotension may be caused by dehydration or blood loss. Chronic orthostatic hypotension, on the other hand, may be caused by disorders of the neurologic, cardiovascular, or endocrine systems, as well as certain medications.
Orthostatic hypotension can also be symptomatic or asymptomatic. Many people with orthostatic hypotension experience symptoms such as dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headaches. These symptoms are a result of transient insufficient perfusion to organ tissue, mostly the brain. In severe cases, orthostatic hypotension can lead to syncope (fainting), and increase the risk of falls and injuries. However, some individuals with orthostatic hypotension may be asymptomatic, not exhibiting any noticeable symptoms.
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Symptoms include dizziness, blurred vision, weakness, fatigue, nausea, and headache
Orthostatic hypotension (OH) is a condition characterised by a drop in blood pressure that occurs when a person stands up. OH can cause lightheadedness, dizziness, blurred vision, weakness, fatigue, nausea, and headaches. In some cases, it can even cause fainting or a temporary loss of consciousness, known as syncope.
The symptoms of orthostatic hypotension can vary greatly from one individual to another and may be subtle or absent altogether. However, the most common symptom is lightheadedness or dizziness when standing after sitting or lying down. These symptoms usually last for just a few minutes and can be easily treated by sitting or lying down immediately. Other symptoms include blurred vision, weakness, fatigue, nausea, and headaches.
The condition can be acute or chronic, symptomatic or asymptomatic, and is often more common and severe in the morning. It can be caused by dehydration, blood loss, neurological disorders such as Parkinson's disease, cardiovascular issues, endocrine disorders, or certain medications. Chronic orthostatic hypotension is usually a sign of another underlying health problem, and treatment depends on the cause.
To diagnose orthostatic hypotension, a healthcare provider will review an individual's medical history, medications, and symptoms, and may conduct a physical examination. Blood pressure monitoring is also important, as OH is characterised by a drop in systolic blood pressure of 20 mm Hg or a drop in diastolic blood pressure of 10 mm Hg within 2 to 5 minutes of standing. Blood tests and electrocardiograms (ECGs) may also be used to provide information about overall health and the electrical activity of the heart.
Treatment for orthostatic hypotension depends on the underlying cause and severity of symptoms. Lifestyle changes, such as increasing fluid and salt intake, wearing compression stockings, and doing regular cardiovascular exercise, can help manage symptoms. In some cases, medications may be necessary to increase blood pressure or blood volume.
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Causes include dehydration, blood loss, and neurological, cardiovascular, or endocrine disorders
Orthostatic hypotension, also known as postural hypotension, is a medical condition in which a person's blood pressure drops when they stand up or sit down. It is characterised by a drop in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg after 3 minutes of standing.
Orthostatic hypotension can be caused by dehydration, which leads to a decrease in blood volume. Dehydration can be caused by fever, vomiting, insufficient fluid intake, severe diarrhoea, and strenuous exercise with excessive sweating. Mild dehydration can cause symptoms of orthostatic hypotension, such as weakness, dizziness, and fatigue.
Blood loss or decreased blood volume can also contribute to orthostatic hypotension. This can be caused by bleeding, the use of diuretics, or significant weight loss. Additionally, certain medications, such as drugs that cause vasodilation, narcotics, and marijuana, and antidepressants, can also lead to orthostatic hypotension.
Neurological or nervous system disorders, such as Parkinson's disease, multiple system atrophy, Lewy body dementia, and pure autonomic failure, can disrupt the body's ability to control blood pressure, increasing the risk of orthostatic hypotension. Cardiovascular diseases, including heart valve problems, heart attacks, and heart failure, can also lead to orthostatic hypotension by preventing the body from quickly pumping more blood when standing up.
Endocrine disorders, such as thyroid conditions, adrenal insufficiency (Addison's disease), low blood sugar (hypoglycaemia), and diabetes, can also cause orthostatic hypotension. Diabetes, in particular, can damage the nerves that help send signals to control blood pressure.
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Frequently asked questions
Orthostasis is a physiological response of the sympathetic system to counteract a fall in blood pressure when a person moves from a lying down to a standing position.
Orthostatic hypotension is a drop in blood pressure that occurs when moving from a lying down (supine) position to a standing (upright) position. It is characterised by a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing.
Symptoms of orthostatic hypotension include dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. In severe cases, it can also cause syncope (loss of consciousness).
Orthostatic hypotension is more common among older adults, with up to 50% of individuals in long-term residential care facilities experiencing it. It is also associated with an increased risk of cardiovascular disease, including stroke, coronary artery disease, and chronic kidney disease.
