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Orthostatic hypotension (OH)

Orthostatic hypotension (OH) is a common non-motor symptom of Parkinson’s disease (PD) that can cause unexplained falls, syncope, lightheadedness, cognitive impairment, shortness of breath, fatigue, and blurred vision. It is common in older people and can affect up to 20-30% of people with PD. OH can significantly impact the quality of life of those involved, and this condition often requires specialized medical attention from a neurologist in Orlando. It can increase the risk of falls and injuries and can interfere with a person’s ability to carry out daily activities. If left untreated, it can increase the risk of syncope and falls.

Orthostatic hypotension, also known as postural hypotension, is a condition that causes a sudden drop in blood pressure when a person stands up from a sitting or lying position. It can lead to symptoms such as dizziness, lightheadedness, blurred vision, weakness, fainting, confusion, and nausea. In this blog post, we will explain what causes orthostatic hypotension, how it is diagnosed, and how it can be treated.

Orthostatic hypotension can have various causes, such as:

  • Dehydration

    Losing too much fluid from the body due to vomiting, diarrhea, sweating, or taking diuretics (water pills) can reduce blood volume and lower blood pressure.

  • Medications

    Some drugs that lower blood pressure, such as beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and nitrates, can cause orthostatic hypotension. Other medications that can affect blood pressure include antidepressants, antipsychotics, narcotics, and alcohol.

  • Heart problems

    Conditions that affect the heart's ability to pump blood effectively, such as arrhythmias (irregular heartbeats), heart valve disease, heart failure, or heart attack, can cause orthostatic hypotension.

  • Endocrine problems

    Disorders that affect the hormones that regulate blood pressure and fluid balance, such as diabetes, thyroid disease, adrenal insufficiency (Addison disease), or pheochromocytoma (a rare tumor of the adrenal gland), can cause orthostatic hypotension.

  • Neurological problems

    Diseases that damage the nerves that control blood pressure and blood vessel tone, such as Parkinson's disease, multiple system atrophy (MSA), dementia, or spinal cord injury, can cause orthostatic hypotension.

  • Prolonged immobility

    Staying in bed for a long time due to illness or injury can reduce muscle tone and blood volume and lower blood pressure.

Neurologist in Orlando

Orthostatic hypotension (OH)

To diagnose orthostatic hypotension, a healthcare provider will measure your blood pressure while lying down and again after you stand up. You have orthostatic hypotension if your systolic blood pressure (the top number) drops by 20 millimeters of mercury (mmHg) or more or your diastolic blood pressure (the bottom number) drops by 10 mmHg or more within three minutes of standing up.

Your healthcare provider will also ask you about your medical history, medications, symptoms, and lifestyle factors that may contribute to orthostatic hypotension. You may also need some tests to rule out other causes of low blood pressure or to identify any underlying conditions that may be causing orthostatic hypotension.

These tests may include:

  • Electrocardiogram (ECG)

    To record the electrical activity of your heart and detect any arrhythmias or heart problems.

  • Echocardiogram

    To create an image of your heart using sound waves and assess its structure and function.

  • Tilt table test

    To measure your blood pressure and heart rate while you are tilted from a lying to a standing position on a special table. This test can help determine how your body responds to changes in posture and identify any abnormal reflexes that may cause orthostatic hypotension.

  • Autonomic function tests

    To evaluate how your nervous system controls your blood pressure and heart rate in response to various stimuli.

Treatment of orthostatic hypotension

The treatment of orthostatic hypotension depends on its cause and severity. Some general measures that can help prevent or relieve symptoms include:

  • Changing positions slowly

    When you get up from a sitting or lying position, do it gradually and hold on to something for support. You can also flex your legs and feet or cross your legs before standing up to increase blood flow to your upper body.

  • Drinking enough fluids

    Stay hydrated by drinking water and other fluids throughout the day, especially if you are dehydrated, have diarrhea, or take diuretics. Avoid alcohol and caffeine, which can dehydrate you and lower your blood pressure.

  • Eating small, frequent meals

    Avoid large meals that can lower your blood pressure by diverting blood to your digestive system. Instead, eat smaller, more frequent meals that are high in salt, protein, and calories. You can also add extra salt to your food or take salt tablets if your healthcare provider advises you to do so.

  • Wearing compression stockings

    These are tight-fitting socks or stockings that apply pressure to your legs and feet and prevent blood from pooling in your lower extremities. You can buy them at a pharmacy or medical supply store.

  • Elevating the head of your bed

    Raising the head of your bed by about 10 to 20 centimeters (4 to 8 inches) can help prevent blood from pooling in your legs and abdomen while you sleep. You can use pillows, blocks, or wedges to elevate your bed.

  • Avoiding triggers

    ome factors that can worsen orthostatic hypotension include heat, exercise, stress, and prolonged standing. Try to avoid or limit these triggers and take breaks to sit or lie down if you feel dizzy or faint.

  • Using assistive device

    If you have frequent falls or injuries due to orthostatic hypotension, you may benefit from using a cane, walker, wheelchair, or other devices that can help you maintain your balance and mobility.

In some cases, you may also need medications to treat orthostatic hypotension. These may include:

  • Fludrocortisone: A synthetic hormone that increases sodium and fluid retention and raises blood pressure.
  • Midodrine: A drug that constricts blood vessels and increases blood pressure.
  • Pyridostigmine: A drug that enhances nerve signals and improves blood vessel tone.
  • Droxidopa: A drug that increases the levels of norepinephrine, a hormone that regulates blood pressure and heart rate.
  • Erythropoietin: A hormone that stimulates the production of red blood cells and increases blood volume and oxygen delivery.

Conclusion

Orthostatic hypotension is a condition that causes a sudden drop in blood pressure when standing up from a sitting or lying position. It can cause symptoms such as dizziness, lightheadedness, blurred vision, weakness, fainting, confusion, and nausea. It can have various causes, such as dehydration, medications, heart problems, endocrine.