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Orthostatic Hypertension Causes, Symptoms, And Treatment - Healthline
Orthostatic hypertension is a type of high blood pressure. It occurs when a person goes from sitting or lying down to standing.
The body has automatic processes that regulate blood pressure when moving from positions like lying down to standing. In people with orthostatic hypertension (OHT), blood pressure rises despite those processes. This can cause a sensation of lightheadedness or nausea.
OHT is not a well-studied condition. In fact, medical experts do not even currently have a standard definition for it.
Recent proposals suggest that OHT should be defined as an increase in systolic blood pressure greater than or equal to 20 millimeters of mercury (mm Hg) when going from lying down to standing.
It is also not a well-understood condition, and it is often undiagnosed. But there are signs and symptoms that could indicate you have it.
Plus, research does suggest that possible complications are associated with it. That makes diagnosis important.
Like essential hypertension, OHT often does not cause any symptoms. That can make detecting and diagnosing the condition difficult.
If symptoms of OHT do occur, they may include:
Fainting is possible, but it is rare.
Alternatively, orthostatic hypotension is the opposite of OHT. It is low blood pressure that happens when someone stands up quickly. Symptoms of this condition include weakness, leg buckling, and blurred vision.
Temporary OHT could be the result of a condition like dehydration. When the body is not properly hydrated, it can cause issues. In this case, the elevated blood pressure will pass once the underlying condition is treated.
For others, OHT may be the result of a more long-term condition or problem. These include:
Occasional lightheadedness when standing isn't uncommon, and it's rarely anything to be concerned about. But if the condition continues or worsens, it's worth talking with your doctor.
OHT is not always easy to diagnose, especially during a standard appointment. But certain tests can help with diagnosis. These may be done at home or in a clinic.
For example, your doctor may ask you to wear a blood pressure monitor so they can see blood pressure changes as you move from lying down to standing. This test can help them see whether your blood pressure changes and, if so, by how much.
Additionally, a tilt-table test may be used. This allows a doctor to slowly raise you from lying flat to a specific angle. During the test, you will wear a blood pressure monitor.
A systolic blood pressure reading that increases by 20 mm Hg may be adequate to diagnose this condition for most doctors. Yet because there are currently no official guidelines, doctors may differ on their personal opinion of what measurements define OHT.
Currently, there are no treatment guidelines for OHT, either. Most treatments are based on limited studies.
For some people, changes to how they sit up after lying down may help. Slowing down the process might give the body's nervous system more time to respond.
Your doctor won't prescribe blood pressure medication unless they find that you do have high blood pressure. In fact, your doctor may choose to closely monitor your blood pressure for signs that you have developed essential hypertension.
Orthostatic hypertension is a type of high blood pressure that occurs when someone goes from lying down to standing. Typically, the body can regulate blood pressure during movements, but in people with OHT, this regulation fails. Instead, the blood pressure rises.
For most people, the condition will not cause any symptoms. Others may experience lightheadedness. Fainting is even possible, though rare.
OHT is not well-researched, so there are no standard treatments. Doctors typically determine treatment on a case-by-case basis, but almost all people will be monitored for high blood pressure. Research does suggest that OHT may be an early sign or type of hypertension.
Orthostatic Hypertension—a New Haemodynamic Cardiovascular Risk ...
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Postural Hypotension: Symptoms And Management - Nursing Times
Postural hypotension is a common problem in older people, it can present with clinical symptoms of dizziness, syncope and falls when the patient changes position
Jevon P (2001) Postural hypotension: symptoms and management. Nursing Times; 97: 3, p39
AuthorPhil Jevon, BSc, PGCE, RN, is a resuscitation officer, Walsall Hospitals NHS Trust
Postural hypotension is defined as a reduction in systolic blood pressure of 20mmHg or more after standing for at least one minute (Miller, 1999). Also known as orthostatic hypotension, it is a common problem in older people, affecting 10-33% of them (Harris et al, 1991; Patel et al, 1993).
The prevalence of postural hypotension increases with age and it arises as a complication of a number of diseases, for example diabetes. It can present with clinical symptoms of dizziness, syncope and falls when the patient changes position.
Although it may seem to be a relatively harmless phenomenon, patients' safety and quality of life can be seriously affected. An understanding of the causes, together with appropriate nursing management, is essential.
Maintaining blood pressureThe body needs to maintain blood pressure to ensure adequate perfusion of organs, particularly when an organ's functional demands increase. This relies on the integrity of the heart and blood vessels, maintenance of intravascular volume and various circulating and local vasoactive agents (Mathias and Kimber, 1999).
Blood pressure is regulated in part by baroreceptors, which are located in the aortic arch, carotid arteries and carotid sinus. By influencing the heart rate and peripheral vascular resistance via the autonomic nervous system, these help to compensate for transient changes in arterial pressure, maintaining it at a constant level.
Age-related changes in the baroreflex mechanisms can precipitate postural hypotension. The baroreflex-mediated heart rate response to both hypotensive and hypertensive stimuli can become impaired.
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In addition, blood pressure regulation can be affected by age-related and disease-related cardiovascular changes, such as atherosclerosis. Arterioles are less able to constrict in response to rapid changes in position, for example when standing up, which makes older people more susceptible to postural hypotension (Andresen, 1998; Miller, 1999).
Causes and risk factorsAlthough the condition can occur in healthy older people, it is more common in those who have additional risk factors (Miller, 1999). It particularly affects people on prolonged bedrest and those aged over 74. However, it is not confined to the older population.
It can be caused by:
There are also a number of drugs that can cause postural hypotension (Box 1).
Clinical features and diagnosisThe clinical features of postural hypotension relate to the degree of the fall in blood pressure and hypoperfusion of the brain and other organs.
The symptoms may vary from dizziness to syncope, which are both associated with visual disturbances ranging from blurred vision to blackouts (Mathias, 1995).
Other possible manifestations include weakness, angina, low backache and lethargy (Bleasdale-Barr and Mathias, 1998). Sometimes the patient may not have any symptoms.
One of the most common complaints older patients present with is a history of falls. Other symptoms include confusion and continence problems.
Diagnosis of postural hypotension involves demonstrating a postural fall in blood pressure after standing. The patient's lying and standing blood pressure measurements should be taken, preferably in the morning (See Practical procedures, p41).
In a patient who has unexplained syncope and falls, the symptoms need to be reproduced to make a diagnosis. Assessing for the presence of postural hypotension is particularly relevant in older people with a history of falls (Jordan and Torrance, 1995).
Further investigation in a dedicated laboratory using a tilt table may also be necessary to ensure that patients with profound postural hypotension or with associated neurological disabilities can be returned to a horizontal position rapidly and safely (Mathias and Kimber, 1999).
Non-invasive 24-hour blood pressure monitoring may determine whether the patient has hypotension when standing and night-time hypertension when lying down. After eating a meal, the patient may experience a significant fall in blood pressure that may be a symptom of the condition. Again, this can only be diagnosed by measuring the patient's standing blood pressure after a meal (O'Brien et al, 1995).
Nursing management and lifestyle adviceFor patients with symptomatic postural hypotension, it is important to alleviate the symptoms and prevent them from recurring so as to minimise the risk of injury and maintain the patient's quality of life. Key aspects of the nursing management of a patient with postural hypotension are described in Box 2.
It is of primary importance to provide patient education before discharge. Advice to the patient should include, for example, taking care when changing from a sitting to a standing position and when taking medication that could precipitate postural hypotension (Box 3).
Medical managementIn patients with chronic postural hypotension the aim is to ensure appropriate mobility and function, prevent falls and provide low-risk treatment while maintaining a suitable quality of life (Mathias and Kimber, 1999). If possible, the cause should be treated.
When non-pharmacological treatment measures are not wholly successful, drugs that help to raise the blood pressure may be considered: for example, although fludrocortisone is not licensed for the treatment of postural hypotension it is usually the drug of choice (Mathias and Kimber, 1999). Its actions include volume expansion and the promotion of arteriole vasoconstriction.
ConclusionPostural hypotension is a common condition in older people. The lying and standing blood pressure measurements of all older patients should ideally be taken routinely. If they are taking hypotensive-inducing medication it is essential to monitor their lying and standing blood pressure (Mader, 1989).
Nurses have a key role in monitoring, maintaining and promoting a safe environment and providing lifestyle advice for patients with postural hypotension.
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