Orthostatic hypotension

Orthostatic hypotension

Orthostatic hypotension is low blood pressure that is triggered by a change in body position when standing. Orthostatic hypotension is generally a symptom of another condition or disease.

Orthostatic hypotension occurs when a person feels dizzy or faints when standing up from sitting or lying down. This condition appears as a result of a delay or disruption in the body's natural response in maintaining blood pressure.

Mild orthostatic hypotension generally lasts only a few minutes. If it lasts longer, orthostatic hypotension can be a sign of a more serious medical condition. If left untreated, the condition can trigger complications, such as stroke and heart failure.

Causes of Orthostatic Hypotension

When a person stands up from sitting or lying down, the blood will automatically flow to the legs due to the force of gravity. In this condition, blood circulation to the heart is reduced so that blood pressure drops.

Normally, the body will create a natural response to restore the lowered blood pressure. However, in patients with orthostatic hypotension, the response is disturbed so that it does not work well.

Mild orthostatic hypotension may occur occasionally. Generally, mild orthostatic hypotension is caused by innocuous conditions, such as mild dehydration, lack of sleep, mild hypoglycemia, or exposure to extreme heat.

If it occurs too often, orthostatic hypotension may be caused by a more serious illness, such as:

  • Cardiac dysfunction, such as bradycardia, coronary heart disease , heart attack, and heart failure
  • Endocrine gland disorders, such as Addison's disease and hypoglycemia
  • Dehydration, for example due to not drinking enough water, fever, vomiting, diarrhea, or excessive sweating
  • Nervous system disorders, such as Parkinson's disease and multiple system atrophy
  • Blood pressure drops after eating ( postprandial hypotension ), which usually occurs in the elderly
  • The use of drugs to overcome hypertension, heart disease, or depression, such as ACE inhibitors , calcium-channel blockers (CCBs) , angiotensin receptor blockers ( ARB ), diuretics and beta inhibitors

In addition to the above conditions, there are other factors that can increase a person's risk of orthostatic hypotension, namely:

  • Aged 65 years or older
  • Having a family member who suffers from orthostatic hypotension
  • Live in a hot environment
  • Not being active or moving for a long time, for example because of bed rest when being treated in hospital
  • is pregnant
  • Consuming alcoholic beverages

Symptoms of Orthostatic Hypotension

Orthostatic hypotension can occur with or without symptoms. This condition occurs more often in the morning with more severe symptoms. This is because blood pressure is at its lowest in the morning.

Symptoms of hypotension are usually only felt for a few minutes. These symptoms can include:

  • Dizziness when getting up from sitting or lying down
  • Blurred vision
  • The body feels weak
  • Bewildered
  • Nausea
  • Heart pounding
  • Shortness of breath
  • Pass out

When should you go to the doctor?

If orthostatic hypotension only occurs occasionally, a doctor's examination may not be necessary. However, it is recommended to record the symptoms experienced, as well as when and how long the condition occurs.

If orthostatic hypotension occurs at a dangerous time, such as while driving, it is recommended to consult a doctor .

Immediately check with a doctor if orthostatic hypotension occurs frequently, especially when accompanied by more serious symptoms, such as:

  • Chest pain
  • Fall or faint
  • A broken bone or head injury from a fall
  • Difficulty walking
  • Poor body coordination or balance
  • Stools are dark black or contain blood
  • Symptoms of shock include rapid breathing, weak pulse, and sweaty, bluish skin, and feeling cold

Diagnosis of Orthostatic Hypotension

The doctor will ask questions related to the patient's symptoms and health history, followed by a thorough physical examination. After that, to confirm the diagnosis and find out the cause, the doctor can carry out the following tests:

  • Blood pressure examination
    This test is performed by measuring blood pressure using a tensiometer while the patient is sitting and standing, then comparing them.
  • Blood
    test Blood test aims to check the patient's health condition comprehensively. Blood tests are also used to detect hypoglycemia or anemia that can trigger a drop in blood pressure.
  • Electrocardiography
    Electrocardiography (EKG) uses a special device in the form of electrodes that are placed on the patient's chest, legs, and hands. The device functions to detect electrical activity in the heart.
  • Echocardiography
    Echocardiography is an examination using sound waves (USG) to produce images of the condition of the heart.
  • Stress test
    Stress test is an EKG performed to check the condition of the patient's heart when working harder, such as when exercising (running on a treadmill ).
  • Tilt table test
    In the process, the patient will be asked to lie on a special bed that can be rotated. After the patient is lying down, the doctor will check the patient's blood pressure in different positions.
  • Valsalva maneuver
    In this test, the patient will be asked to follow the movements instructed by the doctor. The purpose is to check the function of the autonomic nervous system, by assessing heart rate and blood pressure.

Treatment of Orthostatic Hypotension

Orthostatic hypotension treatment methods can be different for each patient, depending on the underlying cause. Here are some treatments that can be done according to the cause:

  • Immediately sit or lie down to relieve symptoms
  • Drink a lot to overcome dehydration
  • Consult with a doctor regarding drug dosage or changing the drug used
  • Taking medication or undergoing surgery to treat heart problems
  • Eat in smaller portions to overcome postprandial hypotension

In addition, there are several treatment methods that can be used to help increase blood pressure, namely:

  • Consult a doctor first if you want to do a low-salt diet
  • Wearing compression stockings or socks, to prevent blood pooling in the legs and help increase blood pressure throughout the body
  • Consuming drugs to increase volume and blood pressure, the type and dosage of which is determined by the doctor

Complications of Orthostatic Hypotension

Orthostatic hypotension that has lasted for a long time and is left untreated risks complications, such as:

  • Falling and causing serious injury, such as broken bones or concussion
  • Organ dysfunction due to lack of blood flow
  • Stroke
  • Heart disease, such as heart rhythm disorders or heart failure

Prevention of Orthostatic Hypotension

There are several things that can be done to prevent orthostatic hypotension, namely:

  • Drink plenty of water to avoid dehydration
  • Avoid hot places
  • Sleep with a higher pillow so that the head position is slightly higher
  • Eat smaller portions but often
  • Exercise regularly to improve heart function, but not excessively
  • Get enough sleep and rest
  • Do not cross your legs when sitting
  • Getting used to standing up slowly from a sitting or lying position
  • Do not stand without moving for a long time
  • Avoiding the consumption of alcoholic beverages
  • Do not drink tea or coffee in excessive portions
  • Check blood pressure regularly
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