Also known as orthostatic hypotension or postural hypotension medically (hypotension means low blood pressure), it is a sudden drop in blood pressure that happens when a person stands up. This drop in blood pressure can make you feel dizzy or lightheaded. Some other people may experience blurry or dim vision, weakness or even fainting (this is called syncope). All these symptoms occur immediately after standing up from either a sitting or lying down position.
This condition is common among the elderlies, mostly above 65 years of age, whose blood vessels have become hardened, have weaker hearts and poor nervous functioning and hence aren’t able to adjust immediately to sudden blood pressure changes. About 20% of elderly people over age of 65 years suffer from postural hypotension.
There are many causes of postural hypotension. Dehydration, which occurs when one loses more body fluid than they taken in, can cause one not to have enough fluids in the blood vessels, and this can cause postural hypotension. You can become dehydrated if; you do not drink enough fluids, if you have severe diarrhea or vomiting, if you sweat a lot (for example, during exercise).
Diseases of the heart which impair its ability to pump strongly enough, or if onesnerves and hormones that control the blood vessels are not working properly can cause symptoms of postural hypotension. Certain medications such as drugs for treating high blood pressure or some drugs that affect the nervous system can cause this condition too.
Pregnancy is often associated with the above symptoms of postural hypotension, which usually normalize after child birth. Chronic alcohol use is a known risk factor.
In some people, postural hypotension is tied to another problem, such as diabetes or Parkinson disease. But people who are otherwise healthy can have the condition, too.
To determine if your symptoms are due to postural hypotension, the doctor listens to the history of your symptoms, does a physical examination and there are a few tests that can be done to confirm or rule out other medical conditions with almost similar symptoms. The simplest test is to take your blood pressure and pulse while you are sitting or lying down and then again after you stand up. Other tests can be done might include; blood tests to see if you have a condition called “anemia,” which happens if you have too few red blood cells causing almost the same symptoms, and tests to make sure one’s heart is pumping effectively. For many cases, the diagnosis of postural hypotension can be made based on the patient’s history of symptoms and physical examination without further testing.
Symptoms of postural hypotension are usually brief, giving the person a chance to sit down or hold onto some support, but more serious symptoms like fainting can lead to falling with possible subsequent serious trauma to the body such as head injury which can be fatal.
The wide dramatic changes in blood pressure as one stands and sits can be a risk factor for developing a certain form of stoke due to the reduced blood flow to the brain.
Treatment for this condition depends on its specific cause. If it is found to be due to dehydration, adequate body rehydration usually through drinking plenty of oral fluid will be advised and any diseases such as vomiting or diarrhea treated appropriately if they are the cause of the dehydration. If it is found to be due to specific medications one is taking, a different drug can be prescribed or the doze reduced. There are also medicines used to treat this postural hypotension directly, and the doctor might decide to prescribe one of these after assessing the severity of the condition.
Once the diagnosis of postural hypotension has been made, there are a few changes that one can do to reduce or overcome the bothersome condition, although medical care should be sought first. Standing up slowly and giving one’s body time to adapt. This is especially important when one gets out of bed in the morning. Start by sitting up and waiting a moment, then swing your legs over the side of the bed and wait some more. When you do stand up, make sure you have something to hold onto in case you start to feel dizzy.
Avoid running, or doing anything that takes a lot of energy in hot weather which might worsen the symptoms. Drinking enough fluids, especially in hot weather to prevent dehydration helps in preventing or even overcoming the symptoms of postural hypotension. Use of special compression stockings which are worn and help to prevent stagnating of blood in the legs and the waist, raising the head of the bed when sleeping, avoiding excess alcohol consumption, and many other lifestyle modifications can help to reduce on the symptoms.
Dr. Ian Shyaka is a
General Practitioner at Rwanda Military Hospital