Orthostatic Hypotension

Orthostatic hypotension is the sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within the first 3 minutes of standing or head-up tilt on a tilt table (1).

Upon standing from a supine position, there is a pooling of blood in the lower extremities secondary to gravitational forces. The human body normally compensates with stimulation of the sympathetic system and diminished activity of the parasympathetic system. When patients lack this compensatory mechanism, there is a reduction in venous return to the heart, resulting in a decrease of cardiac output. Consequently, blood pressure drops, and the patient develops symptoms of orthostatic hypotension (2).

Orthostatic hypotension may be caused by neurogenic causes, such as Parkinson disease, diabetes, as well as non-neurogenic causes, such as hypertension, aortic stenosis and heart failure. Orthostatic hypotension may be induced by several medications, alcohol consumption, or it may be the result of idiopathic conditions.

Common symptoms of patients with orthostatic hypotension are dizziness, transient loss of consciousness, falls, blurry vision, fatigue and chest pain (3).

The prevalence of orthostatic hypotension increases with age (4). The prevalence of orthostatic hypotension is estimated at 5 – 11 % in middle-aged people and at 15 – 25 % in people aged 65 years or older (5).

Diagnosis is performed by specialized physicians. Diagnosis of orthostatic hypotension may require examinations, such as blood pressure monitoring, tilt table test and electrocardiogram (6). Physicians evaluate the condition of patients. Treatment decisions are made by specialized physicians.