Have you ever wondered why you sometimes feel dizzy or lightheaded when you stand up from a seated or lying position? This sensation can be attributed to a physiological phenomenon called orthostatic hypotension, often referred to as postural hypotension. Postural hypotension is a prevalent condition among older individuals, frequently encountered in emergency departments and medical admissions units. While it can resolve on its own, it may lead to dizziness, lightheadedness, or, in severe cases, fainting. Therefore, recognizing and addressing it proactively is crucial to prevent potential adverse outcomes.
Pathophysiology of Postural Hypotension
When a person stands up, a significant amount of blood, around 500 to 1,000 ml, moves from their chest area to their legs, buttocks, abdomen, and pelvis. The body has to deal with the challenge of redistributing blood to the lower half of the body. This bloods tends to accumulate in the lower abdominal region and less bloods returning to the heart – this can cause a drop in blood pressure. Our body mechanism counteract this, such as increased in heart rate and vasoconstriction. However, in older people, these mechanism may not work as efficiently, leading to postural hypotension.
Contributing Factors
Several factors contribute to the development of postural hypotension, including dehydration, prolonged bed rest, deconditioning after prolonged immobilization, medications (such as antihypertensives, anticholinergics, antidepressants, and sedatives), age-related changes in the autonomic nervous system, certain medical conditions like Parkinson's disease, alcohol excess, and severe anemia.
Why Postural Hypotension is important to diagnose ?
Postural hypotension, if left unaddressed, can lead to dizziness, lightheadedness, and even fainting. Moreover, it's associated with cognitive decline and an increased risk of developing dementia.
Diagnosis Made Sample
Diagnosing postural hypotension is straightforward in most of the cases. It involves measuring blood pressure while lying down and immediately upon standing, and after three minutes of standing. A drop of > 20 mmHg in systolic blood pressure (BP) or > 10 mmHg in diastolic blood pressure after standing for three minutes indicates postural hypotension.
Managing Postural Hypotension : Keep it Simple
The goal of treatment is to alleviate symptoms, improve mobility, and increase standing duration. Management of postural hypotension often doesn't require medications. Instead, simple lifestyle changes can make a significant difference:
- Stay Hydrated: Hydration is key. Ensure you're drinking water or juice regularly throughout the day. Aiming for around 2 liters (approximately 4 pints) of fluids daily can be beneficial.
- Rise Gradually: When getting out of bed, take your time. Sit on the edge of the bed for a moment, take a few deep breaths, and ensure you're feeling steady before standing up.
- Sit Up Slowly: Whether you're rising from a sitting position or lying down, wait until any symptoms have subsided before walking off. Patience can prevent sudden drops in blood pressure.
- Mind Your Meals: Opt for smaller, more frequent meals rather than large ones. This helps stabilize blood pressure and reduces the risk of post-meal dizziness.
- Watch Your Caffeine and Alcohol: Consider cutting back on tea, coffee, and alcohol, as these can sometimes exacerbate postural hypotension.
- Salt Can Help: Adding a little extra table salt to your meals may help regulate blood pressure, but be cautious not to overdo it.
- Moderate Bath Temperatures: When bathing, avoid very hot showers or baths, as extreme temperatures can influence blood pressure.
- Morning Hydration Ritual: Keep a cold glass of water by your bedside to drink before rising in the morning.
- Stay Active: If you need to stand for extended periods, try periodically tensing and relaxing your calf muscles, like gentle walking in place.
- Consider Compression Stockings: Wearing compression stockings that reach above the knee can promote better circulation. Remember to remove them at night.
- Sleep Smart: Elevate the head of your bed by about 4 inches. This head-up position during sleep can be helpful.
- Stay Upright: Avoid prolonged periods of lying down. Try to remain upright and mobile throughout the day. Consistent time spent upright can train your body to maintain blood pressure.
- Medication Review: Consult your doctor about the medications you're taking. Some medications may contribute to low blood pressure. In some of the cases, postural hypotension may simply be resolved by stopping some of the blood pressure medications, so it's essential to discuss any concerns.
Medications as a Last Resort
If lifestyle changes aren't enough, doctors may prescribe medications like midodrine, fludrocortisone. These drugs help raise blood pressure but should be used cautiously and under strict medical supervision as those medications can cause supine hypertension.
Conclusion
In conclusion, postural hypotension is a common issue for older individuals but can be managed effectively with lifestyle changes. Understanding the condition and its simple management strategies can significantly improve the quality of life for older individuals dealing with postural hypotension.
References:
- Robertson, D. (2008). The pathophysiology and diagnosis of orthostatic hypotension. Clinical Autonomic Research, 18(2), 2-7.
- Freeman, R. (2008). Clinical practice. Neurogenic orthostatic hypotension. New England Journal of Medicine, 358(6), 615-624.
- Low, P. A. (2015). Prevalence of orthostatic hypotension. Clinical Autonomic Research, 25(2), 69-75.
- Fedorowski, A., Stavenow, L., Hedblad, B., Berglund, G., Nilsson, P. M., & Melander, O. (2010). Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). European Heart Journal, 31(1), 85-91.
- Mar, P. L., & Raj, S. R. (2019). Orthostatic hypotension: a practical approach to investigation and management. Canadian Journal of Cardiology, 35(6), 702-707.