Orthostatic Hypotension or Postural Hypotension – Causes and Symptoms

Orthostatic hypotension is a kind of low blood pressure that develops when you suddenly stand up or lie down. Orthostatic hypotension or postural hypotension is generally mild and lasts for a few minutes. It makes you dizzy, and you may even faint.

What is Orthostatic Hypotension?

Orthostatic hypotension can be of two types, occasional (acute orthostatic hypotension) or chronic orthostatic hypotension. Occasional orthostatic hypotension can be caused by dehydration, low blood sugar or overheating or after a long period of lying down. Chronic orthostatic hypotension on the other hand,  could be caused by some underlying health problems. If your blood pressure falls suddenly, there will be less blood flow to your organs, causing dizziness.

Gravity causes blood to pool in your abdomen and legs when you stand up, which reduces blood pressure as there is less blood circulating back to the heart.

Normally, there are some special cells named baroreceptors near your heart and neck arteries that sense this lower blood pressure. They signal the brain to instruct the heart to beat faster and pump more blood, which stabilizes blood pressure. These cells can also narrow the blood vessels and increase blood pressure.

When this process does not work properly it leads to orthostatic hypotension

Orthostatic hypotension (postural hypotension) becomes more common as you age. Moreover, anemia, dehydration from diarrhea, diabetes, thyroid, heart diseases, neurological problems, pregnancy or prolonged immobility can increase your risk of postural hypotension.

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Some of the methods of diagnosing Orthostatic Hypotension are:

• Blood pressure monitoring: Your doctor will measure blood pressure both while you are sitting and while you are standing and then compare the measurements. If you have a drop of 10 millimeters of mercury (mm Hg) in your diastolic blood pressure or a drop of 20 mm Hg in your systolic blood pressure within two to five minutes of standing or or if standing causes signs and symptoms, your doctor will diagnose orthostatic hypotension.
• Blood tests can detect hypoglycemia (low blood sugar) or anemia (low red blood cell levels), both of which can lead to low blood pressure.
• Electrocardiogram (ECG or EKG): This noninvasive test detects irregularities in your heart rhythm or heart structure
• Echocardiogram. 
• Stress test: Stress test is done while you are exercising, like walking on a treadmill.
• Valsalva maneuver: This is a noninvasive test that checks the functioning of the autonomic nervous system by analyzing heart rate and blood pressure after many cycles of a type of deep breathing that involves you to breathe in deeply and push the air out through the lips –  as if you are trying to blow up a stiff balloon.
• Tilt table test: This test diagnoses how the body reacts to changes in position. You will lie on the flat table that tilts to raise the upper part of the body, which simulates movement from lying down to standing. The blood pressure is frequently taken as the table is tilted

What are the symptoms?

Orthostatic hypotension mostly occurs in the mornings. The reason is that blood pressure is at its lowest in the mornings. The main sign or symptom is dizziness, when you suddenly stand up from a lying or sitting position. Fainting is also a sign of orthostatic hypotension.

Other signs and symptoms of orthostatic hypotension are:

• Blurred vision
• Headaches
• Nausea
• Feeling hot or sweaty
• Chest, shoulder or neck pain
• Difficulty in concentrating
• Heart palpitations
• Shortness of breath

When to see a doctor?

If you suffer from postural hypotension occasionally, it is not serious. You may feel dizzy or lightheaded because of dehydration or low blood sugar. You should consult a doctor if you have frequent symptoms of postural hypotension. Frequent symptoms of postural hypotension could mean that you have a serious underlying health issue. You should seek medical attention immediate if you lose consciousness even for a second as it may indicate a stroke.

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How can you prevent Orthostatic Hypotension?

You can prevent orthostatic hypotension by following these measures:

• Have plenty of fluids: Drinking plenty of water and staying hydrated can help you prevent low blood pressure and its symptoms. 
• Avoid alcohol: You should avoid alcohol as it can worsen symptoms of postural hypotension.
• Exercise: Regular cardiovascular exercise can help you ease symptoms of postural hypotension.
• Avoid bending down the waist: Avoid bending at the waist. Rather squat with your knees when picking something from the floor.
• Get up slowly: You should try to get up slowly from sitting and lying positions. When you wake up after sleeping, sit for a while near the edge of your bed and then stand.
• Raise your head while lying in bed: You should raise your head a little while sleeping to avoid the effects of gravity.
• Move your legs when standing: If you experience any symptoms of orthostatic hypotension, try crossing your thighs and squeezing. This can help ease symptoms.
• Your doctor might suggest eating small frequent meals if your blood pressure drops after meals.

How is Orthostatic Hypotension Treated?

The main purpose of the treatment is to maintain normal blood pressure. Therefore, there must be a proper supply of blood to the lower legs and an increase in blood supply. Treatment of postural hypotension involves treatment of the underlying cause of postural hypotension.

For mild orthostatic hypotension (postural hypotension), treatment involves lying down immediately on feeling dizzy. If you feel dizzy because of some medicines, you can ask your doctor to change the medicine or dose. The treatment of orthostatic hypotension involves:

• Compression stockings: Orthostatic hypotension occurs when there is insufficient blood flow, especially to your lower legs. Compression stockings and abdominal binders might help in increasing blood flow and reducing the symptoms of orthostatic hypotension.
• Medicines: Certain medicines may be used in the treatment of orthostatic hypotension or postural hypotension. Fludrocortisone helps increase blood pressure but has serious side effects. Pyridostigmine combined with Midodrine is also an effective medicine.
• Lifestyle changes: Your doctor might also suggest several lifestyle changes like staying hydrated, avoiding alcohol, avoiding crossing legs while standing up and sitting down slowly. 

Conclusion

Orthostatic hypotension is not a serious ailment if it is not caused by some underlying health issues. You should consult your doctor immediately if it occurs frequently. Your doctor will diagnose the causes of your postural hypotension and treat it accordingly.

Frequently Asked Questions (FAQs)

Is postural hypotension curable?

Postural hypotension symptoms can be controlled through medication, compression stockings and exercise.

Is walking good for orthostatic hypotension?

Regular walking, jogging or swimming can help you reduce symptoms of orthostatic hypotension. However, do avoid workouts in humid, very hot weather. Flex and stretch your calf muscles before sitting up. Squeeze your thighs together, including your abdominal and buttock muscles if symptoms strike. March in place, squat, or rise onto your tiptoes.