Orthostatic hypotension
Authors:
Z. Bartošová; B. Krahulec
Authors‘ workplace:
Prednosta: doc. MUDr. Ľudovít Gašpar, CSc.
; II. interná klinika UNB a LFUK, Bratislava
Published in:
Prakt. Lék. 2011; 91(9): 517-521
Category:
Reviews
Overview
Orthostatic hypotension (OH), defined as a reduction of systolic blood pressure of at least 20 mm Hg and/or diastolic blood pressure of at least 10 mm Hg within 3 minutes after standing up or while using a head-up tilt table (so called head-up tilt test), is a common finding in a clinical practice, especially in elderly patients. Its presence is associated with a significantly higher morbidity and mortality.
There could be either functional causes of OH e.g. due to medication or states of volume depletion or neurogenic causes that result from lesions of afferent, central or efferent pathways of blood pressure control in autonomic nervous system dysfunction.
Patients with OH could be asymptomatic or manifest symptoms such as dizziness, presyncope and weakness with a higher risk of falls associated with syncope that impair the quality of life of such patient.
The diagnostic evaluation requires a precise blood pressure measurement during standing up or head-up tilt test, taking a history focusing on other possible symptoms of autonomic neuropathy and secondary causes of OH and laboratory and imaging studies with regard to a specific patient.
The aim of the treatment in case of symptomatic patient is to improve the quality of life and minimize the impeding symptoms as much as possible, not to achieve the arbitrary blood pressure. This could be achieved first of all by nonpharmacological approach together with avoidance of potentially reversible causes such as hypotensive medications. In case of failure we step up to the pharmacological agents such as midodrin, 9-α-fluorohydrocortison, ephedrine or nonsteroidal anti-inflammatory drugs.
Key words:
orthostatic hypotension, functional and neurogenic causes, autonomic neuropathy, blood pressure measurement, head-up tilt test.
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General Practitioner
2011 Issue 9
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