Suggest treatment for orthostatic hypotension

Posted on Wed, 26 Nov 2014 in Hypertension and Heart Disease
Question: I have been diagnosed with "orthostatic hypotension" because sometimes when I raise up from a squat I' m light headed or blank out for a few seconds. Twice it happened when standing--3 years ago I got a pacemaker, but about 6 weeks ago again from standing--so went to "same Day care, had an ECHO gram and a CT scan, but nothing shows up. I tried to find it in WebMD but had not luck. So far the only solutions are: keep hydrated, breathe deeply as I get up, and have a cane or walking pole handy. Any suggestions, or references would be greatly appreciated. Thank you.
Answered by Dr. Shafi Ullah Khan 1 hour later
Brief Answer:
Orthostatic hypotension

Detailed Answer:
Orthostatic Hypotension is found in greater than 20% of elderly patients after age 60. An important cause of orthostatic hypotension in elderly is decreased baroreceptor sensitivity. Other causes like acute volume depletion, automomic neuropathy such as due to diabetes, the use of antihypertensive drugs such as nitrates or antidepressants all can contribute towards orthostatic hypotension.
Initial treatment of orthostatic hypotension is focused on nonpharmacological maneuvours such as removal of pharmacological agents. use of elastic stockings,
physical manevours and exercise.
Arising slowly, in stages, from supine to seated to standing. This maneuver is most important in the morning, when orthostatic tolerance is lowest.
Avoiding straining, coughing, and walking in hot weather; these activities reduce venous return and worsen orthostatic hypotension.
Raising the head of the bed 10 to 20 degrees decreases renal perfusion, thereby activating the renin-angiotensin-aldosterone system and decreasing nocturnal diuresis. These changes relieve orthostasis by expanding extracellular fluid volume and may reduce end organ damage by reducing supine hypertension.
The use of custom-fitted elastic stockings permits the application of graded pressure to the lower extremities and lower abdomen, thereby minimizing peripheral blood pooling. It is essential that such stockings extend to the waist since most peripheral pooling occurs in the splanchnic circulation. These stockings are poorly tolerated by many patients, particularly those with painful peripheral neuropathies or motor dysfunction.
Exercise may be beneficial when cardiovascular deconditioning rather than chronic autonomic failure is the cause of orthostatic hypotension. As an example, a small study of five elderly patients in whom tilt-table testing at baseline resulted in symptoms showed that an exercise regimen consisting of walking or climbing stairs for 30 to 45 minutes per day three times per week for six months resulted in symptom disappearance during a repeat tilt-table test.
Another maneuver that may be effective is tensing the legs by crossing them while actively standing on both legs. Squatting produced a similar benefit.

If these nonpharmacological maneuvers don't work for you, then in those resistant cases, you may use fludrocortisone and or midodrine however I must add here they can cause hypertension by themselves and in case of patients with cardiovascular compromise are not recommended at all.

Caffeine in the morning is probably helpful to most patients . Also NSAIDs as supplement may be used in refractory cases.
Hope it helps. Please don't forget to close and rate the question.
Dr. Khan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3614 Questions


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