ORTHOSTATIC

HYPOTENSION
 CLINICAL QUESTION
A 60 years old male comes to the OPD department with complaints of dizziness, nausea, and fatigue which
occur when the person stands from the supine or sitting position.
• The symptoms fade away after some time.

• On measuring BP
• 120/80 in the supine position
• 90/60 after standing from supine position

• patient has a very long history of diabetes mellitus(more than 20 years)

• What is the probable diagnosis and management for this disease?
 What is Orthostatic Hypotension?

It is defined as a fall in systolic blood pressure of at-least 20 mmHg or

diastolic blood pressure of at least 10 mmHg after 3 mins of standing from
the supine position.

⚬It occurs in only 5% of middle aged adults but affects

approx. 20% of those 60 years or older

⚬With increasing age ,there is normal decline in baroreceptor sensitivity

and further there are increased chances of neurogenerative diseases.
 Symptoms
⚬The symptoms of orthostatic hypotension include
dizziness, lightheadedness, blurred vision,
weakness, fatigue, and nausea. In severe cases, it
can lead to fainting and falls
.
⚬Patients with diabetes mellitus are more likely to
develop orthostatic hypotension and have an
increased risk of mortality and cardiovascular
events.
⚬These symptoms can have a significant impact on
a person's daily life, making it difficult to perform
normal activities such as standing for long periods
of time or driving.
 PATHOPHYSIOLOGY
⚬Approx. 500-1000 ml of blood pools in the lower extemities when a person stands , causing a decrease in
venous return and cardiac output

⚬Baroreceptors detect decreased stretch and activate the sympathetic nervous system, which elevates the heart
rate, increases contractility and peripheral resistance

⚬It also prompts upregulation of renin release, sodium reabsorption and vasopressin activity leading to increase
in water retention.

⚬In orthostatic hypotension there is inadequate intravascular volume or when sympathetic nervous system
mediated vasoconstriction is unable to compensate for the gravitational pooling,leading to decreased organ
perfusion and associated symptoms.
 CLASSIFICATION
Orthostatic hypotension is further classified as

1)Neurogenic
2) Non-neurogenic
 NEUROGENIC
⚬Neurogenic orthostatic hypotension is caused by an intrinsic failure of the autonomic nervous system to
create a normal physiological response.

some of the causes are:-

⚬spinal cord injury
⚬traumatic brain injury
⚬dementia
⚬Parkinson disease
⚬diabetes mellitus
⚬pure autonomic failure
 NON-NEUROGENIC
⚬non-neurogenic orthostatic hypotension is secondary to external factors inhibiting the body's
normal compensatory patterns

some of the causes are-

⚬adrenal insufficiency
⚬hyperglycemia
⚬medications
⚬infections
⚬AIDS
⚬distributive shock
⚬alcohol abuse
 Diagnosing Orthostatic Hypotension

To diagnose orthostatic hypotension, a doctor

may perform a physical exam and take a medical
history. They may also conduct a tilt table test,
where the patient lies on a table that is tilted
upright to simulate standing up.

During the test, the doctor monitors the

patient's blood pressure and heart rate to see
how they respond to the change in position.
Other tests may include blood tests and
electrocardiograms (ECGs).
 MANAGEMENT
Treatment goals for orthostatic hypertension are reducing symptoms and improving quality of
life rather than normalizing blood pressure.

Steps-
⚬consider discontinuing causative medications
⚬increase hydration and sodium intake
⚬physical fitness
⚬treat reversible causes(eg. anemia)

If treatment goals are not achieved

⚬add medications (eg. droxidopa)
THANKS