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Orthostatic-Hypotension Part 2 Of 6

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Click Here to Download this Blog Post –  Orthostatic Hypotension: Part 1 Of 6

Dr. Nicholas L. DePace, M.D., F.A.C.C.

This is Part 2 of a 6 Part Series about Orthostatic-Hypotension

Orthostatic hypotension could be due to impaired autonomic reflexes or intravascular volume depletion (dehydration). Symptoms commonly include dizziness, muscle aches, lightheadedness, fainting, and discomfort in the neck and shoulders, a so-called coat hanger syndrome. Even anginal chest pain can occur with orthostatic hypertension. Other symptoms commonly seen are blurred vision, generalized weakness, cognitive impairment, nausea, palpitations, tremulousness, headaches, and, as mentioned, presyncope and syncope. These symptoms can be incapacitating in patients who have more advanced forms of orthostatic hypotension and can impair them from even walking 10 or 20 feet before they have to sit down or lean against an object. Even more troublesome is that many people who have orthostatic drops have symptoms of autonomic dysfunction in other organs, such as the stomach (gastroparesis), the colon (constipation), the bladder (bladder dysfunction), and in the sweat glands (anhidrosis or the inability to sweat). Some people sweat in patchy distributions and not throughout their whole body and loose body water sweating in certain parts of the body. More worrisome is when orthostatic hypotension is accompanied by movement disorders that can affect balance and gait.

Patients also with postural orthostatic tachycardia may have similar symptoms as described above, as those with postural orthostatic hypotension. In these patients, the blood pressure does not drop, and they usually do not have fainting episodes. Rather, they have racing heart rates, often above 120 and 130 beats per minute. Usually, they are a younger subset of patients, whereas patients over the age of 50 usually will manifest orthostatic hypotension with blood pressure drops. Patients with postural orthostatic tachycardia syndrome, or POTS as it is commonly called, are normally seen in patients in their teens, 20s, and 30s but not commonly after the age of 40

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Orthostatic-Hypotension Part 1 Of 6

Posted by
Click Here to Download this Blog Post –  Orthostatic Hypotension: Part 1 Of 6

Dr. Nicholas L. DePace, M.D., F.A.C.C.

This is Part 1 of a 6 Part Series about Orthostatic-Hypotension

Orthostatic hypotension is defined as a decrease in systolic blood pressure greater than or equal to 20 mmHg or diastolic blood pressure greater than or equal to 10 mmHg within three minutes of one assuming the upright position.  Most of the time by two minutes, one could get a reliable estimate if orthostatic hypotension is present.  If someone has significant supine high blood pressure or hypotension, that is when they are lying down their blood pressure is greater than 160 systolic, we often require a systolic blood pressure drop of 30 mmHg or greater.   There are occasional rare cases where we see delayed orthostatic hypotension when the blood pressure will drop after three minutes, and this may actually represent a mild form of an abnormality of the sympathetic nervous system.  The sympathetic nervous system is like the accelerator of a car, and the parasympathetic nervous system is like the brakes of a car.  This is an analogy that we often use.   An accelerated sympathetic nervous system will raise heart rate and blood pressure

When syncope, or fainting, occurs, studies have shown that orthostatic hypotension may be responsible for about ten percent of the time for this.  In one European study, up to a quarter of syncope-associated complaints were associated with orthostatic hypotension in the emergency room.  Orthostatic hypotension, or more specifically neurogenic orthostatic hypotension, as it is often referred to, usually occurs in about one-fifth of patients over the age of 65 years of age and increases with age.  Many hospitalized patients, if they are tested, will show this, even if they are not symptomatic.  In addition, if one shows evidence of orthostatic hypotension, it is a strong predictor of future cardiovascular events and is in itself an adverse marker portending a worse prognosis in patients who have it.  Patients who have severe drops in orthostatic hypotension are even more jeopardized to have future cardiovascular events and, of course, falls as time goes on.  It is a serious disorder that needs to be recognized and treated aggressively.

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