What are the key terms to understand Orthostatic Hypotension?

A person’s blood pressure is written in the form of two numbers. For example, the blood pressure is written as 120 over 80 mm of mercury. The first number, 120, is called the systolic pressure, or the pressure inside the arteries when a person’s heartbeats and fills it with the blood. The second number, 80, is called the diastolic pressure, or the pressure inside the arteries when a person’s heart rests in between the beats. 

What is Orthostatic Hypotension?

The word orthostatic which means the upright posture of the body, and hypo or less and tension are also known as pressure is the term being used to define the sudden fall of a person’s blood pressure when a person suddenly stands. 

Whenever one person stands up from either sitting or lying down, a person’s body must adjust to the sudden change in position. It is most necessary for the body to be able to push the blood going up and supply enough oxygen to the brain. If ever the body fails to be able to this, the person’s blood pressure falls, and they might feel dizzy, lightheaded, and even pass out.

The proper and adequate blood supply in a person’s body always depends on three factors. The first is a heart that is strong enough to pump blood, the arteries, and the veins that can either constrict or squeeze, and lastly, enough blood and fluid inside the vessels. 

If a person changes his body position, a variety of actions happen that involve every part of the cardiovascular system, and the autonomic nervous system, which helps regulate the functions of each.

The autonomic nervous system is also considered to be the “run in the background” of the body. This regulates the process of the body that people take for granted. This is also responsible for the balance of the sympathetic system, the nerves that speed it up, and the parasympathetic system, nerves that slow it down. These are based on the type of chemicals that are used to transmit the signals at the nerve endings. 

The adrenaline which comes from the nervous system lets the body respond to the sudden stress. For example, when you see a bear in the woods, your heartbeat gets faster, your palms are sweaty, your eyes are dilated, and your hair stands on end.

On the other hand, acetylcholine is a chemical that is anti-adrenaline and is one of the chemicals involved parasympathetic nervous system. 

The two systems mentioned above are in balance, and yet they need to be able to respond to the routine changes in your body that happened throughout the day.

When your body moves from a sitting or lying down to standing position, the pressure monitors that are located inside the carotid arteries and the aorta sense the subtle drop in your blood pressure that is caused by gravity, which then causes the blood to flow to your legs. 

After that, almost immediately, the sympathetic system is then stimulated, which causes the heart rate to increase and the heart muscle to contract or squeeze more forcefully, which causes the blood vessels to be contracted or become narrow.

All these are the actions that serve to make sure that the blood pressure increases, and there is a sufficient amount of blood pumped to the brain and the other organs. 

Without the changes, gravity will cause the blood to remain in the lowest part of the body, away from your brain, and will be the cause of lightheadedness and even passing out.

Contrary to common misconception, Orthostatic Hypotension is not a disease nor a complaint from a person. Instead, it is an abnormal change in a person’s blood pressure and heart rate that is associated with an illness. It would be best if you remembered that when a person’s brain does not get enough blood supply, it will shut down.

Just like any other illness, Orthostatic Hypotension has symptoms that are similar to other diseases. Always keep checking yourself to make sure you are experiencing symptoms of Orthostatic Hypotension. Some of it includes sudden lightheadedness, confusion, nausea, and even fainting or passing out. It also includes weakness, blurred vision and shaking, and tremulousness.

The symptoms may be resolved as quickly as a person’s body adjusts to the standing position. However, there are cases that the person has to quickly lie down or even sit to be able to prevent from passing out and falling.

Causes of Orthostatic Hypotension

Orthostatic Hypotension is caused by a lot of different things that happen inside a body. Some of it includes aging since older people commonly experience orthostatic Hypotension; dehydration, or low fluid volume in the body, pregnancy, immobility, or staying too long in bed, and heart conditions, which includes heart attack, heart failure, irregular heart rhythm, and valve diseases.

It can also be caused by hypovolemia or the sudden drop in the volume of the blood, anemia, or low count of red blood cells; Parkinson’s disease; and diseases in the endocrine system, including diabetes, and the adrenal insufficiency; and the thyroid conditions. 

It can also be caused by medications or substances that are being used to treat different illnesses like blood pressure, including beta-blockers, calcium channel blockers, the ACE inhibitors, some nitrates, and the angiotensin II blockers, medicines for anxiety, depression, erectile dysfunction, and Parkinson’s disease. And substances that are taken together with the blood pressure medications like alcohol, barbiturates, and any other drugs. 

Diagnosis and Treatment

Diagnosis

For the diagnosis of orthostatic Hypotension, the doctor’s goal is to be able to identify the cause of your illness and to find the best appropriate treatment of your health problem that is causing your low blood pressure. Although the cause is not always known, there are many things to determine the cause that the doctor will try. 

Your doctor will need to review your medical background and history and will take note of your symptoms. A series of physical examinations will also be done to you to identify your condition. 

One common physical examination is blood pressure monitoring, where the doctor measures the blood pressure of the patient while sitting and standing, and the results will be compared. The doctor will rule orthostatic Hypotension as his diagnosis if the patient has a drop of 20mm of mercury (mm Hg) in the patient’s systolic blood pressure, or if there is a 10mm Hg drop in the diastolic as long as it is within the two to five minutes of standing up. The doctor will also note the sign and symptoms shown by the patient upon standing up. 

Another test that the patient can take is a Blood test, which is very useful in providing the overall health of the patient, including the low blood sugar or hypoglycemia and low red blood cell levels, also known as anemia. Both of which can be the cause of low blood pressure. 

Electrocardiogram or ECG is also commonly being used to test the irregularities of the patient in the heart, in its rhythm, or its structure. This can also identify the problems a patient has in the blood supply and oxygen supply to the heart muscle. This is a painless, noninvasive test where soft and sticky patches are attached to the patient’s chest, arms, and legs. These patches will detect the patient’s heart’s electric signal, and a machine will either record them on a graph paper or display it on a screen. There are instances that heart rhythm abnormalities appear then disappear, so there are chances that ECG will not detect anything. If this happens, you can ask to wear a 24-hour Holter monitor so your heart’s electrical activity can be recorded as you continue on your daily routine. 

Treatment

For orthostatic Hypotension to be considered treated, normal blood pressure should be restored. Usually, it involves the increase in blood volume, reduction of the pool of blood in the lower legs of the patient, and helps the blood vessels push the blood all over the body. 

Treatment usually addresses the underlying cause of orthostatic Hypotension. It may be dehydration or heart failure, rather than the low blood pressure in itself. 

For the mild orthostatic Hypotension, simple treatments include sitting or lying down immediately when the patient feels lightheaded upon standing up. 

If in an instance, the low blood pressure is caused by medications, the treatment usually involves changing the dosage of your medication or stop taking it immediately. 

You can also try home remedies so that you can manage or prevent orthostatic Hypotension. Some of the home remedies include increasing your salt in your diet, eating small meals or any low-carb meals, take in vitamin supplements, take in plenty of fluids, avoid alcohol, and regular exercise.