If one experiences dizziness or other symptoms of low blood pressure when one rises from a chair or bed, that person most likely suffers from an orthostatic hypotension. This is a chronic ailment that may be difficult to treat.
What is Orthostatic Hypotension?
Hypotension or lowered arterial pressure is observed when the blood pressure in the arteries is below the normal level. The heart muscle pumps blood throughout the organism through blood vessels, which include arteries, veins & capillaries. Arterial pressure means the force of blood pressure on the walls of arterial vessels.
Arterial pressure is measured in mm of mercury (mmHg) and features two main digits:
Systolic: is measured when cardiac ventricles contract and the blood moves into the arterial vessels.
Diastolic: is measured between beats of the heart, when the ventricles are relaxed.
In medicine, orthostatic hypotension definition is as follows: decrease in systolic pressure not less than by 20 mmHg or decrease in diastolic one by 10 mmHg within 3 min of erect standing when compared with arterial pressure in a sitting or standing (“orthostatic”) position. This condition is also known as “postural hypotension”.
This ailment is more common in elderly individuals. This is due to higher prevalence of cardiac diseases and administration of different medicines.
Causes of the Condition
When a person rises, gravity leads to the fact that blood descends into the veins of the lower extremities. This causes a decrease in arterial pressure, because the volume of circulating blood reduces and less blood flows to the heart. Normally, the organism responds correctly to this decrease. Near the heart & neck arteries, there are so-called baroreceptors, which send signals to the human brain and the latter forces the heart to work faster. This leads to a stabilization of the pressure.
Also, baroreceptors narrow the vessels, which again increases the pressure.
Postural reduced pressure develops when something disrupts the natural mechanisms of arterial pressure normalization. The causes of the condition may be different.
According to Mayo Clinic, the main reasons include:
Dehydration. If you drink little liquid, suffer from fever or diarrhea, water quickly leaves the body and the volume of circulating blood decreases. This leads to symptoms of postural hypotension.
Endocrine diseases. Some problems with the thyroid gland and adrenal glands can cause the condition. In addition, hypotension may be triggered by diabetes mellitus, as this disease disrupts the work of the nerves that are responsible for releasing signals of increased pressure.
Cardiac diseases. Slower heart rhythm, heart failure, and some other cardiac illnesses worsen the organism's ability to respond quickly to changes in conditions when a person rises.
Diseases of the nervous system. Some diseases, in particular Parkinson's disease & dementia with Lewy bodies, can disrupt the nerves that regulate vascular tone and pressure.
Eating. Consumption of large amounts of food can cause symptoms of hypotension in some people when they rise. This condition, which is more common in adults and the elderly, is also known as postprandial hypotension.
Heart illnesses, Parkinson's disease cause heart rhythm deteriorations and valve disorders, which leads to symptoms of postural hypotension. The condition can be observed during pregnancy, which is associated with the expansion of the circulatory system. In this case, mild or moderate postural low pressure is not considered a disorder. It disappears after the birth of a child.
Some drugs, such as PDE5 inhibitors (Viagra, Cialis), β-blockers and antidepressants, can cause symptoms associated with postural hypotension. Finally, this ailment can be triggered by smoking marijuana.
Symptoms of the Condition
The most widespread symptom of this condition is dizziness, which occurs when you rise from a sitting/lying position.
Other symptoms include:
hearing loss, tinnitus;
sudden weakness, increased fatigue;
dim vision, blurred vision;
Less common symptoms include headaches, sensation of heaviness in head, pain in chest, shoulder pain, syncopal attack, and dyspnea. The state of health most often deteriorates sharply in the morning, when a patient gets out of bed. In addition, signs of hypotension occur with a sudden change in body position, prolonged standing in one posture, increased physical loads.
Orthostatic Hypotension Diagnosis & Treatment
Sometimes, dizziness and other symptoms can be minor usually due to overheating or non-severe dehydration. They can also occur if you rise after a long sitting. If they are rare, there are probably no serious concerns.
When should you consult a healthcare provider? This should be done, if the symptoms of postural hypotension are observed frequently, as they can signal other more severe health problems. It is strictly recommended to consult a healthcare provider if you have fainted even if it lasted only a couple of seconds.
If necessary, the healthcare provider will recommend tests to find out the causes of this condition. If a particular drug causes a decrease in blood pressure, the doctor can adjust the dose or recommend another medicament. Additionally, a specialist can prescribe blood tests and heart diagnostics.
Some medicines may be used to treat the condition.
For instance, fludrocortisone drug (for example Florinef/Floricot*) is administered to increase fluid quantity in the blood, which consequently leads to an increase in arterial pressure. Midodrine exerts its effect by limiting the blood vessels widening.
*Information about Fludrocortisone by link: awcanadianpharmacy.com/item/florinef.html
Patients with orthostatic hypotension are recommended to lead a healthy lifestyle, completely give up smoking and drinking alcohol, spend more time in the fresh air, perform feasible physical work. It is very important to drink enough fluid every day (the average daily water intake rate is 3.7 liters or 15 cups for men and 2.7 liters or 11 cups for women), adhere to proper and balanced nutrition, increase the intake of fresh vegetables and fruit, and do moderate physical exercises.
5 Nondrug Strategies for Orthostatic Hypotension
Scientists J. J. Figueroa and others (2010) state that medication therapy alone is never adequate for dealing with the condition. They recommend the following methods to combat this health disorder:
Abdominal compression. Compression of the abdominal zone leads to an improvement in the symptoms of the ailment. This is due to a decrease in venous capacitance. For this purpose, special elastic abdominal binder may be used. If abdominal compression is not enough, a person may wear compression garments that put pressure on the waist or at least on the hips.
Water drinking. If you quickly drink 2 glasses of cold water (500 ml), you increase the volume of plasma and standing systolic pressure. This simple method will work for about 2 hours. It can be used before your being in a standing position for a long period time, for example, during shopping.
Bed up. Bed-head of a person suffering from this condition should be slightly elevated: by 10 cm (4 inches) or 15-20 degrees to reduce the increased pressure at night.
Countermaneuvers. They imply an isometric compression of the muscles, which are below the waist, for about half a minute. This enhances venous capacitance and increases the return of blood from the lower extremities to the heart. You can also do leg lifts or slowly move in place.
Exercising. Exercises improve the condition of patients, whereas low mobility can aggravate the problem. The researchers recommend choosing exercises in the prone position (swimming) or sitting (cycling) because exercises in the upright position can contribute to the orthostatic pressure reduction.
Some experts advise to consume more salt as it leads to an increase in blood pressure by contributing to the delay of the fluid used. But it should be borne in mind that the WHO does not recommend consuming more than 5g of salt a day to reduce the possibility of heart disease development. On the other hand, increasing salt intake may seem like a better option for patients than using some medicines.
Thus, mild situations of postural hypotension may be treated with nondrug strategies. Moderate and severe cases may require additional drug treatment. It is very important to see a health care provider if you often experience symptoms of this condition, because they can sometimes signal more serious problems with health.
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