Orthostatic Hypotension

(Postural Hypotension)

Definition

Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.
Measuring of Blood Pressure
Placement of Blood Pressure Cuff
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Causes

As you stand, blood falls toward your lower body in response to gravity. To help keep blood in the upper body:
  • Blood vessels in the lower body will tighten to help push blood back up.
  • The muscles in the lower body contract, or squeeze, to help push blood to upper body.
  • The heart will contract a little harder to pump blood up toward the brain.
Blood pressure is also affected by the amount of blood in the blood vessels. Low levels of blood will decrease the blood pressure and make it harder for the body to compensate when you stand. Low blood volume, called hypovolemia, is the most common cause of orthostatic hypotension. It may be due to:
  • Excessive use of loop diuretic medications
  • Vasodilator medications, such as nitrate preparations, calcium channel blockers, or angiotensin-converting enzyme (ACE) inhibitors
  • Dehydration
  • Prolonged bedrest
  • Addisons disease with inadequate salt intake
Orthostatic hypotension will occur when 1 or more of these factors do not work as expected. It may be associated with:
  • Diseases or conditions that impair the nervous system or nerves that control the widening or shrinking of blood vessels
  • Decreased ability of the heart to contract or reaction of blood vessels
  • Medications that can affect the nervous system or cardiovascular system
  • Alcohol—can slow the reaction of the nervous system

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