Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure dramatically decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.
Measuring of Blood Pressure
Orthostatic hypotension has several causes.
- Hypovolemia is the most common cause. It may be due to:
- Impaired autonomic (nerve) reflex due to certain diseases:
- Decreased heart muscle contractility or vascular responsiveness
- Certain drugs:
- Phenothiazine antipsychotic drugs ( ]]>chlorpromazine]]> , promazine, ]]>thioridazine]]> )
- Atypical antipsychotics (eg, ]]>Seroquel]]> )
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
- Increased age
Use of certain drugs:
- Loop diuretics
- MAO inhibitors
- Tricyclic antidepressants
- Tetracyclic antidepressants
- Phenothiazine antipsychotic drugs
- Inadequate fluid intake
- Prolonged bedrest
- Certain diseases or conditions:
Mild to moderate reduction in brain blood flow:
- Visual blurring
Severe reduction in brain blood flow:
- Fainting]]> or brief loss of consciousness (syncope)
Exercise or having eaten a heavy meal may worsen symptoms.
If you experience any of these symptoms do not assume it is due to orthostatic hypotension. These symptoms may be caused by other health conditions. If you experience any one of them, see your doctor.
Orthostatic hypotension is diagnosed when symptoms are present and there is a measured reduction in blood pressure while standing, which is relieved by lying down. The underlying cause must be determined on an individual basis.
Treatment for orthostatic hypotension depends on the cause.
Adjusting Dosage or Type of Medication
When orthostatic hypotension is due to hypovolemia related to medications, an adjustment in the dosage or discontinuing the medication may be needed to reverse the condition.
Orthostatic hypotension resulting from dehydration is treated with fluids and electrolyte (mainly sodium) replacement.
If bedrest is the cause of orthostatic hypotension, symptoms of orthostatic hypotension may be improved by increasing time spent sitting up in bed.
A number of medications may be given to boost blood pressure, including:
In some cases, individuals may be encouraged to increase their intake of salt. Fitted elastic stockings that go up to the waist may be worn. Individuals may need to be taught to rise from lying down, to sit up, and to stand in a slow and gradual fashion. Similarly, they should be discouraged from standing still for too long a time.
If you are diagnosed with orthostatic hypotension, follow your doctor's instructions .
There is no way to prevent orthostatic hypotension if it is a result of other diseases or conditions. However, if your orthostatic hypotension relates to medications, dehydration, or bedrest, you should talk with your healthcare provider about adjusting your medications, drinking adequate fluids, and minimizing bed rest, respectively.
National Institute of Neurological Disorders and Stroke
National Organization for Rare Disorders
Heart and Stroke Foundation
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Goldman L. Cecil Textbook of Medicine . 22nd ed. Philadelphia, PA: Saunders; 2004.
Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007;120:841-847. Review.
Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet . 2005;366:665-675.
The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com .
National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov .
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Last reviewed November 2008 by ]]>Marcin Chwistek, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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