Orthostatic Hypotension (Postural Hypotension)

Risk factors include:Increased age Use of certain drugs: Loop diureticsVasodilatorsMAO inhibitorsTricyclic antidepressantsTetracyclic antidepressantsPhenothiazine antipsychotic drugsQuinidineLevodopaBarbituratesAlcoholInadequate fluid intakeProlonged bedrest Certain diseases or conditions: Atherosclerosis Advanced heart failureAddisons diseaseDiabetesPernicious anemiaAmyloidosisGuillain-Barre syndromeRiley-Day syndromeShy-Drager syndrome SymptomsSymptoms include: Mild to moderate reduction in brain blood flow: FaintnessLight-headednessDizzinessWeaknessConfusionVisual 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. DiagnosisOrthostatic 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. TreatmentTreatment for orthostatic hypotension depends on the cause.

Treatments include: Adjusting Dosage or Type of MedicationWhen 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. Treating DehydrationOrthostatic hypotension resulting from dehydration is treated with fluids and electrolyte (mainly sodium) replacement. Minimizing BedrestIf bedrest is the cause of orthostatic hypotension, symptoms of orthostatic hypotension may be improved by increasing time spent sitting up in bed. MedicationsA number of medications may be given to boost blood pressure, including:FludrocortisoneMidodrineDihydroergotamineIbuprofenCaffeine Other InterventionsIn 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. PreventionThere 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.

RESOURCES: National Institute of Neurological Disorders and Strokehttp://www.ninds.nih.gov National Organization for Rare Disordershttp://www.rarediseases.org CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ Health Canadahttp://www.hc-sc.gc.ca/index_e.html References: Berkow R, Beers MH, Fletcher AJ, eds. The Merck Manual of Medical InformationHome Edition . 2nd ed. Simon and Schuster, Inc; 2003. Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment . 8th ed. St. Louis, MO: Mosby; 2006. 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 . Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120:975-980.Last reviewed November 2007 by Marcin Chwistek, MDPlease 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.