Orthostatic Hypotension

Excerpt

Orthostatic hypotension, also called postural hypotension, is a drop in blood pressure on standing to a certain extent. It hampers the quality of life and increases the risk of falls, cardiovascular diseases, dementia, depression, and death. Orthostatic hypotension is defined as a sudden drop in blood pressure upon standing from a sitting or supine position. Clinically, this is diagnosed by a sustained reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within three minutes of standing after being supine for five minutes or at a 60-degree angle on the tilt table. This sudden drop in blood pressure is usually secondary to failure of the autonomic reflex, volume depletion, or adverse reaction to a medication. Symptoms on presentation are commonly related to cerebral hypoperfusion, but patients can also be asymptomatic. There is also a high rate of morbidity and mortality related to this disease process due to frequent falls, leading to multiple hospital admissions.

Early detection in patients with certain risk factors or symptoms may provide better outcomes and prevent some complications. Current guidance for detecting and managing orthostatic hypotension is varied and based on inadequate evidence. Primary care providers could play a crucial role in screening and detecting orthostatic hypotension. Also, they could help patients make shared management decisions in improving symptoms and reducing risk.

Orthostatic hypotension results from an insufficient physiologic reaction to orthostatic changes in blood pressure. It may be symptomatic or asymptomatic, as well as acute or chronic. In the absence of volume depletion, chronic autonomic failure is generally the cause of orthostatic hypotension in younger patients. A related problem called postprandial hypotension is common in elderly patients and those with autonomic failure. In this disorder, systolic blood pressure drops by at least 20 mm Hg within 75 minutes of having a meal.