What causes orthostatic hypotension?

Posted on Mon, 8 Jun 2015 in Brain and Spine
Question: I have had issue with syncope in the last month along with low blood pressure. I have taken high np med for years. Was admitted to hospital and had several tests. All were negative except tilt table test. Started to pass out when they put nitro under my tongue. Blood press ok heart rate jumped to 153 hot and sweaty nauseous. Reduced blood pressure med. Have had a constant headache since the test. What do u think?
Answered by Dr. Erion Spaho 48 minutes later
Brief Answer:
There is need to find the cause of orthostatic hypotension.

Detailed Answer:
Hello XXXXXXX and thanks for using HCM.

I have read carefully your query and understand your concerns.

First, there is need for some clarifications about your symptoms:
Besides syncope, do you feel dizzy or lightheaded after you stand up? is there confusion, nausea, any weakness?
What improves your symptoms?
How about your appetite? Did you loose weight lately?
Could you please mention names of blood pressure meds?

In my opinion, yours is the condition of orthostatic hypotension, or lowering of blood pressure after standing from laying or sitting position. This is strongly suggested by tilt table test too.

Causes of orthostatic hypotension include dehydration, heart conditions, endocrine problems ( thyroid disfunction, low blood sugar) and some neurologic conditions.

So, if the heart condition after evaluation results not responsible for your symptoms, other causes should be evaluated.

Treatment and prevention depends on cause.

Hope this helps. I remain at your disposal for further questions or clarifications.
Best regards.

Above answer was peer-reviewed by : Dr. Shanthi.E
Follow up: Dr. Erion Spaho 6 hours later
I get slightly light headed with activity like vaccuming. Tire easily. Rest improves tiredness. Sometimes food improves headache. I drink a lot of water throughout the day. Do not drink soda. 3-4 cups coffee. My sugar was checked in hospital. Was fine. Appetite hasn't been good for years. Have lost 5 pounds since in last month. Do not exercise. My blood pressure med is Exforge 160 which I break in half to take. Previously took a whole one. Blood pressure is running around 105/85.

Answered by Dr. Erion Spaho 6 hours later
Brief Answer:
Lifestyle changes help improve symptoms.

Detailed Answer:
Welcome back XXXXXXX

Thanks for the clarifications. In this case, the most probable cause of your symptoms is related to cardiovascular dysfunction, probably related to Exforge use.

Exforge use should be discussed with your treating Doctor regarding to this probable side effect.

There is need for blood pressure measurement in laying, sitting and standing position. In case there is a change of 20 mmHg between laying and standing systolic blood pressure, then the diagnosis is correct.

I think cardiac monitoring will give additional helpful information.

Important things to prevent syncope related to orthostatic hypotension include lifestyle changes, including drinking enough fluids, drinking no alcohol, avoiding hot weather, and standing up slowly.

Compression stockings help in this condition.

Eating smaller and more often meals and exercising helps too.

Hope this helped. Wishing you good health.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Answered by
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3793 Questions


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