Postural Hypotension Causes, Symptoms, Diagnosis and Treatment

Last updated on September 27th, 2022

Postural hypotension is a type of low blood pressure when a person gets up from a seated or lying position. It is also termed orthostatic hypotension. This type of low BP can cause drowsiness or light-headedness or may even result in faintness. Postural hypotension can be mild. Also, its incidents may persist for some minutes or so. Yet, chronic postural hypotension may indicate more severe issues.

Postural Hypotension Definition

What is orthostatic hypotension? It is a sudden drop in blood pressure upon standing or sitting. A person might feel drowsy or even faint. Orthostatic implies a straight pose, while hypotension is low blood pressure. So, the name is postural or orthostatic hypotension.

Now, Let’s Understand What is Blood Pressure?

Blood pressure assesses the pressure of blood against arterial walls when the heart pumps blood via the circulatory system of the body. It involves 2 types of assessments. The calculation of each is done in the units, millimeters of mercury (mmHg):

• Systolic: Artery pressure when the heart beats and fills arteries with blood.
• Diastolic: Artery pressure when the heart is inactive or not working.

The recording of blood pressure is done by a doctor as systolic over diastolic. The healthy blood pressure range for many individuals is under 120/80 mmHg. Readings under 90/60 mmHg are low blood pressure.

Doctors describe postural hypotension depending upon individual blood pressure. A person suffers from orthostatic hypotension if his or her BP falls above 20 mmHg (systolic range) and 10 mmHg (diastolic range) within 3 minutes of getting up.

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Orthostatic Hypotension Symptoms

The most common sign of postural or orthostatic low BP is a sudden drop in blood pressure upon standing. Signs generally persist for some minutes or so. Other signs can be:

• Weakness
• Hazy vision
• Confusion
• Nausea
• Fainting (syncope)

When to Visit a Healthcare Provider

Infrequent faintness or drowsy feelings might be moderately minor activated by mild dehydration, overheating, or low glucose levels. Dizziness might also occur when a person gets up after sitting for a long while. If such signs occur only infrequently, there’s potentially no reason to worry.

It’s vital to visit a healthcare provider in case of recurrent postural hypotension symptoms. As they might indicate severe issues. It’s even more crucial to visit a physician in case a person loses consciousness, even for some seconds. It is better to maintain a record of the signs, time of their occurrence, frequency, and what the person was doing at that time. If these happen at unsafe times, like while driving, speak to the concerned doctor.

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Postural Hypotension Causes

When a person gets up, gravity results in blood pooling in the legs and abdomen. This reduces the blood pressure as less blood circulates back to the heart. Usually, special cells (named baroreceptors) present adjacent to heart and neck arteries sense this reduced BP. The baroreceptors transfer signals to the brain centers. And, this signals the heart to beat quicker and pump a greater amount of blood. This results in stabilization of the blood pressure. Also, these cells narrow the blood vessels and augment the blood pressure.

So, what causes orthostatic hypotension? Postural hypotension happens when something hinders the body’s natural process of countering low BP. Many of the orthostatic hypotension causes can be:

• Heart disorders. A few cardiac problems leading to low BP may involve heart attack, bradycardia (intensely low heart rate), heart failure, and heart valve issues. These health problems may prevent the body from reacting quickly to pump more blood while getting up.
• Dehydration. Fever, serious diarrhea, vomiting, not having plenty of fluids, and strenuous exercise with much sweat may cause dehydration. This reduces blood volume. Mild dehydration may trigger orthostatic hypotension symptoms. These can be fatigue, weakness, or dizziness.
• Consuming meals. Few individuals have low BP after consuming meals (postprandial hypotension). This medical problem occurs more commonly among older adults.
• Nervous system problems. These include Parkinson’s disease, pure autonomic failure, Lewy body dementia, multiple system atrophy, and amyloidosis. All these problems might hinder the body’s normal blood pressure controlling system.
• Endocrine disorders. Low blood glucose, thyroid problems, and adrenal failure (Addison’s disease) all may lead to orthostatic hypotension. Also, diabetes might harm the nerves that transfer signals controlling blood pressure.

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Risk factors

The risk factors for this type of hypotension can be:

• Various medical conditions. A few heart diseases like heart attack, heart valve problems, heart failure; nervous system disorders like Parkinson’s disease, and ailments triggering nerve damage like diabetes, can augment the risk of low BP.
• Age. Postural low BP occurs more commonly in people above 65 years of age. Special cells (baroreceptors) present close to the heart and neck arteries that control BP may slow down with a person’s age. Also, it might be more difficult for an aging heart to accelerate and recompense for BP reduction.
• Medicines. These involve hypertensive drugs like alpha-blockers, diuretics, beta-blockers, nitrates, calcium channel blockers, and ACE inhibitors. Other medicines that might augment the risk of postural hypotension involve antidepressants, medicines for Parkinson’s disease, antipsychotics, medicines for erectile dysfunction, muscle relaxants, and narcotics.
• Alcohol. Alcohol may augment the risk of postural or orthostatic hypotension.
• Heat exposure. Hot surroundings may lead to heavy sweating and perhaps dehydration. This may reduce the blood pressure and activate orthostatic hypotension.
• Pregnancy. As a person’s circulatory system inflates quickly during pregnancy, the BP is likely to fall down. This is normal, and BP generally comes back to the pre-pregnancy level after giving birth.

Complications

Constant postural or orthostatic hypotension may lead to severe complications, particularly in older adults. These are:

• Stroke. BP swings while getting up or sitting down due to postural hypotension might be a risk factor for stroke. This occurs because of a decreased supply of blood to the brain.
• Falls. Collapsing due to fainting is a common complication in individuals experiencing postural hypotension. Bone fractures or concussions occur as a result of falls.
• Supine hypotension: it is a low BP that happens while lying down.
• Heart disorders. Orthostatic hypotension might be a risk factor for cardiac problems and their complications. These include heart failure, chest pain, or heart rhythm issues.
• Postprandial hypotension. This is low BP half an hour to 2 hours following eating (predominantly a high-carb diet).
• Shock or organ failure if the BP remains too low.

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Who is at risk of postural hypotension?

Any person can catch orthostatic hypotension. Health problems become more common with a person’s age. Some factors augment the risk including:

• Heart diseases such as arrhythmias and heart valve problems.
• Anemia or vitamin B12 shortage.
• Neurological disorders like dementia or Parkinson’s disease.
• Endocrine disorders such as diabetes, Addison’s disease, and thyroid problems.
• Pregnancy, particularly during the initial 24 weeks of pregnancy.
• Hypertensive drugs, or medicines for heart problems and depression.
• Dehydration due to vomiting, diarrhea, or diuretics.
• Continued immovability because of ailments, such as pregnancy bed rest.

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Postural Hypotension Diagnosis

A doctor would check the BP while a person is seated, standing, or lying down. People might also get 1 or more of these tests:

• Exercise stress test to assess heart rate during physical exertion.
• Electrocardiogram (EKG) tests the heart rhythm modifications.
• An echocardiogram (echo) checks the heart’s pumping activity.
• Portable EKG devices (Holter monitor) to assess the heart rhythm.
• Blood tests check health problems such as anemia and diabetes.
• A tilt table test safely assesses heart rate, blood pressure, and heart rhythm while a person lies on a table that moves from horizontal to vertical.

Postural Hypotension Treatment

Compression stockings

The objective of postural hypotension treatment is to reinstate normal BP. That generally includes:

• augmenting the blood volume
• lowering the blood pooling in the lower legs and,
• helping blood vessels to push blood all over the body.

Treatment usually deals with the cause, for instance, dehydration or heart failure instead of low BP itself. For mild postural low BP, one of the easiest treatments is to sit or lie back down instantly after feeling dizzy upon standing. The signs fade away. When low BP results due to medicines, treatment generally includes dose change or medicine stoppage.

Orthostatic Hypotension Treatment

Compression stockings

Compression stockings are useful in decreasing the blood pooling in the legs. Also, they help to decrease the orthostatic hypotension symptoms.

Medicines

Some drugs are useful for treating orthostatic hypotension, such as midodrine and droxidopa. Side effects of midodrine may be urinary retention, prickly scalp, and goose-bumps. Side effects of droxidopa may be headache, nausea, and bladder pain. With either medicine, it is better to avoid lying flat for 4 hours after consuming them. This helps to lower the risk of high BP while lying down.

Fludrocortisone is frequently used to augment the quantity of fluid in the blood, which elevates the BP. However, it may lead to some severe side effects. If a person consumes Fludrocortisone, a healthcare provider would monitor him or her for side effects. Another drug is Pyridostigmine, which may be more effective when taken with Midodrine. Side effects may be nausea, abdominal cramps, and diarrhea.

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Lifestyle Changes and Home Remedies

A few easy steps can aid the management and prevention of postural hypotension. Doctors might give numerous recommendations such as:

• Consume small portions. If the BP falls after consuming, a doctor might suggest small, low-carb meals.
• Exercise. Regular cardio exercises are great for decreasing the signs of orthostatic hypotension. It is better to avoid exercising in very hot, humid weather.
• Enhancing the intake of salt in the diet. This should be practiced carefully and after speaking about it to a doctor. An excess of salt may spike the blood pressure beyond a healthy level, producing new health risks.
• Have enough fluids. Proper hydration aids in preventing low BP symptoms. Every person must have enough water before the long duration of standing, or any activities that are expected to activate these signs.
• Avoid alcohol. Alcohol may exacerbate the signs of orthostatic hypotension. Hence, it is good to limit or avoid the intake of alcohol completely.
• Avoid bending at the waist. If a person drops something on the floor, better to squat with the knees to improve it.
• Stand up slowly. A person might be capable of decreasing the drowsiness and light-headedness that may crop up with postural hypotension. This is done by moving slowly from a lying to a standing posture. In addition, when moving out of the bed, it is good to sit on the edge of the bed for some minutes before standing.

FAQs:

References:

1. https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548
2. https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/diagnosis-treatment/drc-20352553
3. https://my.clevelandclinic.org/health/diseases/9385-low-blood-pressure-orthostatic-hypotension

Last Updated on September 27, 2022 by Dr. Damanjit Duggal