Hematology
Orthostatic Hypotension


Overview:
  • Orthostatic hypotension is a condition where your blood pressure drops significantly when you stand up quickly from sitting or lying down. 
  • Its main symptoms include nausea and feeling hot or dizzy. 
  • Orthostatic hypotension treatment sometimes involves making some lifestyle changes.
  • Getting out of bed slowly, while taking the time to change position, prevents feeling dizzy.

What is orthostatic hypotension?
It is a condition where blood pressure drops (reduced level of blood flow). The following are cases when orthostatic hypotension occurs:
  • When you stand up or sit down suddenly or quickly;
  • When you are waking up early in the morning; 
  • When you eat a big meal; 
  • When you are doing sports; 
  • When you are sick;
  • When you feel anxious or worried. 

Other names: Postural hypotension

Cause:
  • High blood pressure (hypertension);
  • Diabetes, heart failure, or atherosclerosis;
  • Certain diuretics, antidepressants, or low blood pressure medications;
  • Neurological diseases (e.g. Parkinson's disease and some types of dementia);
  • Dehydration;
  • Vitamin B12 deficiency, or anemia;
  • Alcohol;
  • Prolonged bed rest.

Symptoms:
Its symptoms may vary from a person to another. They include:
  • Dizziness when standing up;
  • Feeling that you are about to faint or fall;
  • Headache and blurred vision;
  • Feeling pressure across the back of your shoulders or neck;
  • Nausea or feeling hot;
  • Fatigue.

Diagnosis:
Orthostatic hypotension can be confirmed by measuring a person's blood pressure while sitting down and standing up. The doctor then compares between the two measurements. He may also perform a physical exam to find a medical condition that may be causing low blood pressure. Moreover, your doctor may request certain tests like:
  • A blood test
  • An electrocardiogram
  • An echocardiogram (ultrasound of the heart)
  • A stress test where the patient's heart rate is monitored under different levels of physical activity
  • Other tests, including: tilt table test and Valsalva maneuver to see how the body responds to changes and check the functions of the autonomic nervous system. 

Treatment:
Orthostatic hypotension treatment aims to restore normal blood pressure. That usually involves increasing blood volume, reducing the pooling of blood in your lower legs and helping blood vessels to push blood throughout your body. Treatment often addresses the cause rather than the low blood pressure itself. When low blood pressure is caused by medications, treatment usually involves changing doses.

Treatment also involves making some lifestyle changes, which include:
  • Drinking enough water and fluids when dehydrated;
  • Standing up slowly and avoiding staying in a standing position for prolonged periods; 
  • Avoiding crossing your legs when sitting; 
  • Staying in bed for short periods of time if you must stay for medical reasons;
  • Getting out of bed slowly and sitting at the edge of the bed for several minutes before standing up;
  • Doing some exercises, such as: squeezing a rubber ball or towel for a few minutes. These exercises raise blood pressure and may prevent a significant drop in blood pressure upon standing;
  • Elevating the head of your bed and wearing compression stockings. 

Prevention:
  • Update your doctor about any symptoms you have and discuss with him whether to reduce or stop any medications.
  • Get out of your bed slowly; sit at the edge first, and then stand up. 
  • Take your time when you are changing positions, such as: standing up after sitting down.
  • Take your time when you are trying to sit or lie down while bathing, putting on clothes, or doing kitchen chores.
  • Do gentle exercises before and after getting up like elevating your legs.
  • Make sure there is an object to lean on when you stand up. 
  • Avoid walking when you feel dizzy.
  • Drink 6-8 glasses of water every day unless your doctor says otherwise. 
  • Avoid hot showers and baths. 
  • Use extra pillows to elevate your head during sleep.

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