Orthostatic hypotension

Diagnosis

When assessing orthostatic hypotension, a healthcare provider’s goal is to identify the underlying cause and determine an appropriate course of treatment. Your blood pressure will be measured while you are sitting, lying down, and standing by your healthcare provider. In addition to doing an examination, they will inquire about your medical background.

The following procedure may be recommended by a healthcare provider:

• Blood pressure monitoring: This involves taking a blood pressure reading both sitting and standing. Orthostatic hypotension is indicated by a drop in systolic blood pressure of 20 millimeters of mercury (mm Hg) that occurs 2–5 minutes after standing. Orthostatic hypotension is also indicated by a decrease of 10 mm Hg in the diastolic blood pressure, which occurs 2–5 minutes after standing.
• Blood tests: These can provide details about general health, such as low red blood cell counts (anemia) or blood sugar levels (hypoglycemia). Both may result in hypotension.
• Electrocardiogram (ECG): The electrical activity of the heart is measured by this rapid and painless examination. Electrodes, or sensors, are attached to the chest as well as to the arms or legs during an electrocardiogram (ECG). This may indicate abnormalities in the structure or rhythm of the heart as well as issues with the blood and oxygen reaching the heart muscle.

Occasional changes in cardiac rhythm may be undetected. You could be advised by your healthcare provider to keep an eye on your heartbeat while at home. A Holter monitor is a small, wearable gadget that records the heart’s activity while a person goes about their everyday business for up to a day.

• Echocardiogram: The heart in action may be seen through the use of sound waves. The heart’s and its valves’ blood flow may be seen on an echocardiogram. Structural cardiac disease can be identified with the test.
• Stress test: A stress test is conducted while engaging in physical activity, such treadmill walking. Individuals who are unable to exercise may be prescribed medication to increase heart rate. After that, tests like echocardiogram and electrocardiography are used to monitor the heart.
• Tilt table test: The body’s response to positional changes is demonstrated through a tilt table test. Lying on a flat surface that tilts to elevate the upper body is part of the test. The posture shifts to reflect the transition from lying down to standing. With the table inclined, blood pressure readings are obtained often.

Lying flat on a table is the first step in a tilt table test. The individual is held in position by straps. The table is tipped to a position that approximates standing after it has been flat for some time. The healthcare provider observes how the heart and the neurological system that regulates it react to the positional changes.

• Valsalva maneuver: It is necessary to inhale deeply and exhale through the lips, as if attempting to inflate a rigid balloon. Throughout the examination, blood pressure and heart rate are monitored. The effectiveness of the autonomic nervous system is assessed with this non-invasive test.

Treatment

Orthostatic hypotension treatment focuses on addressing the underlying cause, rather than the low blood pressure itself. Here’s how treatment and management options are typically approached:

Lifestyle adjustments

• Hydration: Increase water intake, especially before activities that may trigger symptoms.
• Dietary changes: Carefully increase salt intake after consulting with a healthcare provider, and opt for small, low-carbohydrate meals to avoid blood pressure drops post-eating.
• Alcohol consumption: Reduce or eliminate alcohol to mitigate worsening symptoms.
• Physical activity: Engage in regular cardiovascular and strengthening exercises, avoiding extremely hot and humid conditions.
• Compression stockings: Use waist-high compression stockings during the day to improve blood flow and reduce symptoms, removing them at bedtime.

Medications

When lifestyle changes are insufficient, medications might be necessary:

• Midodrine: Increases blood pressure by restricting blood vessels.
• Droxidopa: Enhances blood pressure through increased norepinephrine levels.
• Fludrocortisone: Aids in increasing blood volume.
• Pyridostigmine: Improves nerve signal transmission to blood vessels.

Consult your healthcare provider for the most suitable medication and understand potential risks and benefits.

Symptom Management Strategies

• Immediate response: Sit or lie down at the first sign of lightheadedness upon standing.
• Slow movements: Gradually transition from lying to standing positions and remain seated on the bed’s edge before standing.
• Physical maneuvers: Stretch and flex calf muscles before getting up, squeeze thighs, stomach, and buttock muscles for immediate symptom relief, or perform movements like squatting, marching in place, or rising onto tiptoes.
• Bed positioning: Elevate the bed’s head to counteract gravity’s effects during sleep.

These strategies can help manage or prevent orthostatic hypotension, enhancing quality of life for those affected.