We all experience that one moment when we get up very fast and cannot see anything for five seconds. It is all because of Postural Hypotension, in other words, head rush or Orthostatic Hypotension. What is Orthostatic Hypotension definition? Orthostatic Postural Hypotension is a unique kind of Hypotension that commonly causes dizziness and impacts an individual when they are standing from sitting or lying position. It usually occurs on raising the head from the position where the head is below your heart, but this situation may also arise on raising the head from the prone or supine position where the head is at the level of the heart.
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Postural Hypotension is a type of hypotension just like other cases in it. Still, we study this Hypotension as an individual Subject because it is not a disease, but an abnormal change in the heart rate and the blood pressure. Lets us get into the details about it. What is hypotension? Come, Let us Know Hypotension Symptoms, Hypotension Range, and many other unknown things here.
What is Postural Hypotension? or Postural Hypotension Definition
Postural hypotension may be defined as a drop in the systolic blood pressure by at least 20mm Hg or falling up of the diastolic blood pressure by at least 10mm Hg on changing posture (body position) from sitting or lying position to a more vertical or upright position. It is more common in older people but may affect the individuals of any age. It is usually mild and lasts only for a few seconds and is commonly experienced by many people occasionally. Thus, mild Postural Hypotension is not a matter of concern. If this problem becomes chronic, Postural Hypotension may be a sign of more serious health issue for a patient. Also, if you lose your consciousness do not take it lightly and do consult your doctor immediately. Do you Know what are the causes of low Blood Pressure? How to treat low Blood Pressure? To get your question answered, first of all, know the Reason for Low Blood Pressure
How does Postural Hypotension happen?
Orthostasis is primarily caused due to the blood pooling induced by the gravity in the lower extremities. Because of this venous return is compromised, cardiac output decreases and arterial pressure lowers subsequently. It, in turn, causes insufficient perfusion of the blood in the brain and other upper body parts. Thus, as the body posture changes, it causes a temporary reduction in the flow of blood to the brain. It causes a shortage of oxygen supply to the brain, which causes lightheadedness, dizziness and sometimes a loss of consciousness and is named as Postural Hypotension.
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Let us discuss this in detail. To maintain the adequate blood supply to all the bodily organs the following factors are responsible:
1. Your heart should be robust enough to pump the blood.
2. Your veins and arteries should be able to squeeze properly.
3. There should be sufficient fluid and blood in your blood vessels.
What Causes low Blood Pressure (Postural Hypotension)?
Whenever a change occurs in the position of the body, various actions occur. It involves both autonomic nervous system and cardiovascular system to regulate the body processes. The sympathetic nervous system, also known as adrenergic nerves is responsible for speeding up the things and parasympathetic nervous system, also known as cholinergic nerves slow down the things. A chemical known as Adrenaline that is released by the sympathetic nervous system prepares the body to respond to the stress. On the other hand, Acetylcholine is released by the parasympathetic nervous system which acts as anti-adrenaline. The balance between the two is necessary to respond to the changes that the body faces throughout the day. Also, keep a note of Orthostatic Blood Pressure.
Postural Hypotension Causes or Causes of Low Blood Pressure:
There are pressure monitors, known as baroreceptors located in the aorta and carotid arteries. When our body moves to an upright position, the gravity makes the blood flow downwards towards the legs. Causes of Postural Hypotension subtle drop in the blood pressure that is sensed by the baroreceptors. It, in turn, causes the sympathetic nervous system to get stimulated and in response, the heart rate increases, the heart muscle contracts with more force and blood vessel constricts. All this, in turn, increases the blood pressure so that the adequate amount of blood is supplied to the brain and other parts of the body. These changes are crucial. In the absence of these changes or delay in the construction of the lower body, blood vessels the blood remains in the bottom part of the body. Thus, the brain does not receive proper blood and oxygen supply.
In other words, as we change our position, our body has to work on it to quickly adjust to the changes that have occurred. For this, it becomes vital for the body to thrust blood upwards so that the oxygen supply to the brain is maintained. But in the case of Postural Hypotension, our body fails to make this adjustment quickly and adequately.
Postural Hypotension Symptoms
In the absence of enough blood supply, our brain begins to shut down and results in the following symptoms of low Blood Pressure:
- Dizziness or lightheadedness – This is the most common symptom of Postural Hypotension.
- Blurry vision
- Generalized weakness
- Fainting or passing out- this may cause injury.
- Poor concentration
- Pale look
- Blurred vision
These symptoms appear in a short period of standing up and lasts only for a few seconds. In the case of Postural Hypotension, an individual may suffer from just a couple of the above mentioned symptoms or their combination. Usually, as the body slowly adjusts to the standing position mild symptoms subside, but sometimes, it requires lying down or sitting to prevent from falling.
What are the factors that may cause Postural Hypotension?
Postural Hypotension is caused due to the interruption of the body’s natural mechanism of counteracting low blood pressure. It may be caused due to several potential causes. Some of these causes may affect only one part of the blood supplying system to the brain or may affect more than one system. The secondary causes of orthostatic hypotension that causes blood pressure to fall greater than normal are usually medications or low blood volume disease. All these factors are discussed below.
Loss of fluid or small blood volume within the blood vessels is one of the commonest secondary causes in developing the symptoms of Postural Hypotension. Depending on the cause, the fluid may be blood or water. The reason behind hypovolemia may be bleeding, dehydration, prolonged bed rest and use of the diuretics.
It is a condition where the amount of the fluid lost by the body is more than the fluid intake. Common causes of dehydration are diarrhea, vomiting, fever, heat exhaustion and heat stroke.Anemia and blood loss due to any injury or bleeding disease also decreases the red blood cell count. Red blood cells carry oxygen to the various parts of the body. A reduction in the number of RBC’s in the bloodstream may lead to orthostatic hypotension.
In the case of bleeding disorders if the bleeding occurs slowly, then over the period our body becomes capable of compensating or, replacing the lost red blood cells in the bloodstream with water. But the loss of RBC’s affects the blood’s oxygen-carrying capacity. It causes symptoms of Postural Hypotension to develop. But in this case besides experiencing lightheadedness patient may also suffer from generalized weakness, chest pain, and shortness of breath.
Many times Postural Hypotension may be a side effect of antidepressants. If you are taking medicines that affect the autonomic nervous system, you may experience orthostatic hypotension.Beta blockers such as metoprolol (Inderal) may also cause Postural Hypotension as they block the beta-adrenergic receptors. It, in turn, prevents your heart from speeding up, from contracting forcefully and dilating the blood vessels. All this disrupts the body’s ability to react to changes in the posture.
The medicines such as Viagra, Levitra, and Cialis dilates the blood vessels and may cause Postural Hypotension. If they are taken along with the nitrates, which is used to treat angina, the effect is more magnified. Narcotic painkillers and medications for high blood pressure may be a cause.
There is a condition called as a vasovagal episode that occurs due to excess activation of the parasympathetic nervous system. The pain caused due to damage for example broken bones may act as the stimuli for such a reaction. It slows the heart rate and the dilation of the blood vessels. It results in the decrease in the blood pressure. As the blood flow to the brain decreases it results in lightheadedness or passing out. A psychological trigger may also be responsible for such type of reaction.
After the meals:
It is a common cause of Postural hypotension in older people. It is also known as Postprandial Hypotension where blood pressure decreases after eating the meals. The reason behind this is that to help digestion the blood vessels of the intestine and the stomach dilates causing a drop in the standard blood pressure.
Following diseases may also cause Postural Hypotension
Many patients who have diabetes develop peripheral neuropathy. It is a condition that affects the autonomic nervous system and results in orthostatic hypotension. Another reason because of which diabetic patient may suffer from Postural Hypotension is that due to poorly-controlled diabetes, they become dehydrated.
The adrenal insufficiency may be responsible for the body’s inability to adjust to the Postural changes.
Some heart diseases such as heart valve issues, heart failure, heart attack, or bradycardia prevent the body from responding rapidly to variations in the position. It leads to low blood pressure and orthostatic hypotension on standing.
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Nervous system diseases:
Parkinsonism, multiple system atrophy, amyloidosis, and pure autonomic failure are a few nervous system disorders that may disrupt the blood pressure regulation.
It may also be a cause orthostatic hypotension.
Risk factor for Postural Hypotension
The risk factors related to orthostatic hypotension are as follows
Orthostatic Hypotension is more common in the people above 65 years of the age than younger ones. The reason behind this is that with the advancing age, the blood pressure regulation by the baroreceptor slows. Also, it becomes hard for the heart to pump blood faster and beat faster cope up with the drop in blood pressure.
As discussed above, certain medications such as beta blockers, alpha blockers, diuretics, calcium channel blockers, nitrates, antidepressants, muscle relaxants, and angiotensin-converting enzyme increase the risk of Postural Hypotension.
3. Certain diseases:
Certain heart conditions, nervous system diseases, and endocrine disorders may be the cause.
4. Heat exposure:
Extreme hot environment results in excessive sweating and may cause dehydration, which ultimately lowers the blood pressure.
5. Bed rest:
Chronic bed rest causes weakness, and the blood pressure may drop on standing up.
During pregnancy, the circulatory system expands which causes the blood pressure to drop. However, This is very normal, and the blood pressure returns to the normal after delivery.
7. Avoid Alcohol may also be a cause.
Diagnosis of Postural Hypotension
It is necessary to find the underlying cause of orthostatic hypotension to evaluate the condition. It will help the doctor plan the treatment. The doctor may first ask you some questions related to the symptoms you experience, history of any disease, medication, and lifestyle. Also, physical examination may be conducted. Your blood pressure is monitored and, doctor may ask you to have the following test:
- Blood test- To rule out hypoglycemia and anemia.
- Electrocardiogram- To detect any irregularity in the heart rhythm and the structure of the heart.
- Stress test- Perform while exercising.
- Tilt table test- To evaluate how your body reacts to change in the posture.
- Valsalva maneuver
Postural Hypotension Treatment
To treat the Postural Hypotension, we must understand that it is important to address the underlying cause. Thus, the treatment varies according to the underlying secondary cause. Possible treatment involves:
1. Changing the dose or stopping the medication that is causing it.
2. Compression stocking or abdominal binders that reduce the pooling of the blood in extremities.
3. Fluid replacement in the case of dehydration.
4. Medications- Your doctor may also suggest some medicines treat orthostatic hypotension such as midodrine or fludrocortisone.
Lifestyle modifications to treat Postural Hypotension
By indulging a few changes in your lifestyle and diet, you may prevent Postural Hypotension. Following are the suggestions for the same:
Plan your Day:
1. Make a little increase in the intake of common salt in your diet. But do remember that too much increase in the salt intake may increase the blood pressure above the healthy level.
2. Eat small meals at short intervals.
3. Drink lots of fluids.
4. Before sitting better exercise your calf muscles.
5. Avoid Bending at the waist.
6. Always rise slowly.
7. While Sleeping, the patients should make sure to elevate the head with the help of pillows.
8. When you stand, do move your legs. Cross your thighs with the beginning of the dizziness on standing or attain a squatting position quickly to avoid fainting.
9. Avoid sitting with your legs crossed or with your knees up to the chest.
These are the Tips that we want to follow daily to prevent the above mentioned Symptoms. The above factors are the causes of Postural Hypotension. So, better know them and avoid if possible. Also, Consult a doctor and take Medication for low Blood Pressure. Hope everything goes well by following these simple Routine.