Orthostatic Hypotension: Features, Causes, Symptoms, Treatment, and Surgical Methods

Orthostatic hypotension (OH) refers to an abnormally low blood pressure that occurs when suddenly standing up from a lying or sitting position. This is usually caused by inadequate blood circulation and can cause fainting, dizziness, and fatigue. Orthostatic hypotension is a symptom caused by a rapid change in blood pressure due to a change in posture, mainly occurring when blood vessels fail to adequately respond to counteract the concentration of blood in the lower body due to gravity.

Definition of Orthostatic Hypotension

Orthostatic hypotension is generally defined as a decrease in blood pressure of 20 mmHg or more, or an increase in pulse rate of 30 beats or more, when standing up from a lying position. This phenomenon usually occurs immediately after standing or sitting up, and blood pressure naturally recovers after a certain period of time. However, if this hypotensive state is repeated or occurs continuously, orthostatic hypotension may be diagnosed.

Characteristics of Orthostatic Hypotension

The main characteristic of orthostatic hypotension is a rapid drop in blood pressure with changes in posture. Generally, when sitting or standing up from a lying position, blood pools in the lower body due to gravity. In normal cases, blood vessels respond, bringing blood from the lower body to the upper body to maintain blood pressure; however, in people with orthostatic hypotension, this response is insufficient, resulting in lower blood pressure.

The main characteristics of orthostatic hypotension are as follows:

• Dizziness or lightheadedness: This mainly occurs when standing up or getting up from a seat, due to a rapid drop in blood pressure resulting in insufficient blood flow to the brain.
• Fainting or loss of consciousness: If the blood pressure drops very low, insufficient oxygen and blood are supplied to the brain, which can cause loss of consciousness.
• Rapid heart rate: When blood pressure drops, the heart may increase its heart rate to deliver blood faster.
• Fatigue: Poor blood circulation can cause fatigue.

Causes of Orthostatic Hypotension

Orthostatic hypotension can be caused by various factors. The main causes include neurological, endocrine, and cardiovascular problems.

1. Neurological causes

• Autonomic nervous system problems: The autonomic nervous system regulates the constriction and relaxation of blood vessels to maintain blood pressure. Problems with the autonomic nervous system can cause orthostatic hypotension. Representative examples include Parkinson's disease, multiple sclerosis, and autonomic neuropathy.
• Abnormal autonomic response: If the autonomic nervous system does not function properly, the vascular response to postural changes is delayed, causing a rapid drop in blood pressure.

2. Endocrine causes

• Adrenal insufficiency (Addison's disease): A deficiency of hormones secreted by the adrenal glands can make it difficult to maintain blood pressure.
• Hypothyroidism: A lack of thyroid hormone can affect metabolism, leading to low blood pressure.

3. Cardiovascular causes

• Heart failure: If the heart is weakened and cannot pump blood properly, blood pressure can drop.
• Arrhythmias: Irregular heart rhythms can prevent proper blood circulation, causing hypotension.

4. Medication and other causes

• Adverse drug reactions: Some medications, such as diuretics, antidepressants, and antihypertensive drugs, can cause orthostatic hypotension.
• Dehydration: A lack of body fluids reduces blood volume, lowering blood pressure.

Symptoms of Orthostatic Hypotension

Symptoms of orthostatic hypotension appear due to a drop in blood pressure caused by sudden changes in posture. The main symptoms are as follows:

• Dizziness: Dizziness may occur when standing up or getting up from a seat, especially in the morning.
• Fainting: Fainting can occur if blood pressure drops sharply, and this can occur at varying frequencies depending on the individual.
• Lightheadedness: This is a state in which it is difficult to maintain body balance, and there is a feeling that the head is spinning.
• Headache: Headaches can occur as blood pressure decreases.
• Fatigue and weakness: Insufficient blood circulation can cause general fatigue.

Treatment of Orthostatic Hypotension

Treatment for orthostatic hypotension varies depending on the cause and focuses on alleviating symptoms. The main treatment methods are as follows:

1. Lifestyle changes

• Get up slowly: Getting up slowly instead of suddenly can prevent a sharp drop in blood pressure.
• Hydration: Sufficient hydration is needed to prevent dehydration.
• Avoid standing up after meals: Blood pressure tends to drop when standing up after meals, so it is advisable to rest for a while.

2. Medication

• Aldosterone-like drugs: Drugs that help raise blood pressure may be prescribed.
• Midodrine: This drug constricts blood vessels to increase blood pressure.
• Fludrocortisone: This can be used to increase fluid and sodium retention to raise blood pressure.

3. Assistive devices

• Compression stockings: Wearing medical compression stockings to help blood flow upward from the lower body can be effective.

Surgical methods for Orthostatic Hypotension

Orthostatic hypotension is usually managed with medication or lifestyle changes, and surgery is rarely necessary; however, surgical treatment may be necessary in cases with specific causes.

• Heart-related problems: For example, if orthostatic hypotension is caused by a heart-related problem, surgery may be needed to treat the heart condition.
• Neurological causes: If the autonomic nervous system is the cause, some neurological treatments may be necessary, but surgery is rarely used.

Prognosis and Management of Orthostatic Hypotension

The prognosis for orthostatic hypotension depends on the cause. If the cause is simply dehydration or a drug side effect, symptoms may improve after treatment. However, chronic orthostatic hypotension can significantly affect daily life. If there is a more serious underlying cause, such as autonomic nervous system disease or heart disease, the prognosis may be more difficult.

Management methods

• Regular exercise: It is good to regularly engage in exercise that can promote blood circulation.
• Healthy diet: It is important to avoid low-salt or high-fat diets and consume adequate nutrients.
• Adequate hydration: You should drink enough water throughout the day to prevent dehydration.
• Careful medication management: Medications should be taken according to the doctor's prescription, and side effects should be carefully monitored.

Conclusion

Orthostatic hypotension is a condition that causes dizziness and fainting due to a sharp drop in blood pressure when standing up, and various treatment methods are needed depending on the cause and symptoms. Orthostatic hypotension can be effectively managed through lifestyle changes, medication, and hydration. If symptoms persist, customized treatment tailored to the cause is necessary with the help of a specialist.