#hypotension #standing #orthostatic #postural #bloodflow #blood #dehydration #hypertension #management #disease #elderly
Do you get out of bed quickly?
Yes
No
What is orthostatic hypotension?
Orthostatic hypotension, commonly called postural hypotension, is the dramatic drop in blood pressure when we stand up quickly [1]. Blood collects in our legs and feet, causing a temporary reduction in blood flow to the heart [1].
While orthostatic hypotension is more severe in the morning as we wake up, orthostatic hypotension occurs every time our body experiences a quick change in posture (sitting to standing) [2].
Approximately 5% of people <50 years old experience orthostatic hypotension, while this jumps to 70% for people >70 years old [3].
Orthostatic is mainly asymptomatic [3].
Causes of orthostatic hypotension?
Long-term bed rest [3]
Dehydration [1,3]
Pregnancy [1,4]
Existing cardiovascular diseases (either diagnosed or undiagnosed conditions) [4]
Some medications [1]
Excessive vomiting or diarrhoea [1,4]
Kidney failure [4]
Neurodegeneration, such as dementia [5]
An impaired connection between the brain and the blood pressure receptors [6]
Ageing [7]
Autoimmune diseases [1,4]
Symptoms of orthostatic hypotension
Lightheaded
Dizziness
Fainting
Falls
Chest pain [1-7]
Consequences & dangers of orthostatic hypotension
Chest pain
Stroke
Dizziness and lightheaded
Heart failure
Heart rhythm problems, such as atrial fibrillation
Increased risk of falls (and associated injuries from falls)
Quality of life might be affected [1-7]
Prevention & management of orthostatic hypotension
Identify the underlying cause of the orthostatic hypotension
Individualised treatment (no generalisation)
Drink plenty of water before bed
Avoid alcohol before bed
Elevating your head during normal sleep
Compression sock during sleep
Exercise
Take more time getting out of bed (slowly change your posture) [2]
More appropriate and better management of other pathological and heart diseases [1-7]
Quit smoking [8]
Who is most at risk?
Those who have current cardiovascular diseases, such as hypertension or atrial fibrillation [1-7]
Elderly (65 years and older) [2]
Smokers [8]
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References:
[1] Benvenuto LJ, Krakoff LR. Morbidity and Mortality of Orthostatic Hypotension: Implications for Management of Cardiovascular Disease. American Journal of Hypertension. 2011;24(2):135-44.
[2] Gorelik O, Fishlev G, Litvinov V, Almoznino‐Sarafian D, Alon I, Shteinshnaider M, et al. First morning standing up may be risky in acutely ill older inpatients. Blood Pressure. 2005;14(3):139-43.
[3] Ricci F, Caterina RD, Fedorowski A. Orthostatic Hypotension. Journal of the American College of Cardiology. 2015;66(7):848-60.
[4] Fedorowski A, Ricci F, Hamrefors V, Sandau KE, Chung TH, Muldowney JAS, et al. Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem. Circulation: Arrhythmia and Electrophysiology. 2022;15(3):e010573.
[5] Young TM. Orthostatic hypotension and dementia: Associated but not guilty. 2022.
[6] Olshansky B, Muldowney J. Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension. The American Journal of Cardiology. 2020;125(10):1582-93.
[7] Low PA. Prevalence of orthostatic hypotension. Clinical Autonomic Research. 2008;18(S1):8-13.
[8] Ko H-L, Min H-K, Lee S-W. Risk of chronic kidney disease associated with orthostatic hypotensive stress: A community-based Korean study. American Journal of Hypertension. 2022.
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