Materiały źródłowe

• #1 Orthostatic hypotension (postural hypotension) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548

  Orthostatic hypotension also called postural hypotension is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting. […] It’s important to see a health care provider if you frequently feel lightheaded when standing up. […] Chronic orthostatic hypotension is usually a sign of another health problem, so treatment depends on the cause. […] It’s important to see a health care provider for frequent symptoms of orthostatic hypotension. Losing consciousness, even for just a few seconds, is serious. It requires seeing a provider right away. […] Many conditions can cause orthostatic hypotension, including dehydration, heart problems, endocrine problems, nervous system disorders, and eating meals. […] The risk factors for orthostatic hypotension include age, medications, certain diseases, heat exposure, bed rest, and alcohol. […] Persistent orthostatic hypotension can cause serious complications, especially in older adults. These include falls, stroke, and cardiovascular diseases.

• #1 Preventing and treating orthostatic hypotension: As easy as A, B, C

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2888469/

  Orthostatic hypotension is a chronic, debilitating illness that is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and function rather than to achieve upright normotension, which can lead to supine hypertension. Drug therapy alone is never adequate. Because orthostatic stress varies with circumstances during the day, a patient-oriented approach that emphasizes education and nonpharmacologic strategies is critical. […] This review focuses on the prevention and treatment of neurogenic causes of orthostatic hypotension. We emphasize a simple but effective patient-oriented approach to management, using a combination of nonpharmacologic strategies and drugs clinically proven to be efficacious. The recommendations and their rationale are organized in a practical and easy-to-remember format for both physicians and patients.

• #1 Orthostatic hypotension (postural hypotension) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/diagnosis-treatment/drc-20352553

  Exercising. Regular cardiovascular and strengthening exercises might help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid weather. […] Getting up slowly. Move slowly from a lying to standing position. Also, when getting out of bed, sit on the edge of the bed for a minute before standing. […] Raising the head of the bed. Sleeping with the head of the bed slightly raised can help fight the effects of gravity.

• #1 Orthostatic hypotension (postural hypotension) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/diagnosis-treatment/drc-20352553

  A health care provider’s goal in evaluating orthostatic hypotension is to find the cause and determine treatment. The cause isn’t always known. […] Treatment for orthostatic hypotension is directed at the cause rather than the low blood pressure itself. For example, if dehydration causes orthostatic hypotension, your health care provider may suggest lifestyle changes such as drinking more water. […] Some simple steps can help manage or prevent orthostatic hypotension. These include: […] Getting plenty of fluids. Keeping hydrated helps prevent symptoms of low blood pressure. Drink plenty of water before long periods of standing, or any activities that tend to trigger symptoms. […] Avoiding alcohol. Alcohol can worsen orthostatic hypotension, so limit or avoid it completely. […] Increasing salt in the diet. This must be done carefully and only after discussing it with a health care provider. Too much salt can cause blood pressure to increase beyond a healthy level, creating new health risks.

• #1 Postural Hypotention | Home management and remedies

  https://www.movementdisordersclinic.com/postural-hypotension/

  Avoid sudden position changes. Take time to move from one position to other, especially from sleeping and sitting position. Move your legs like marching or cycling for few seconds before you get up […] Keeping your head end of the bed elevated will help to some extent to avoid sudden blood pressure changes […] Avoid large / big meals. Take small quantity and more frequent meals. Suggestions would be to have small meals/snacks once in 3-4 hours. […] Avoid very hot water bath. Hot water bath affects the blood flow pattern, leading to BP fluctuations. […] Use abdominal binders and compression stockings. This will help to reduce the blood pressure drop during sudden posture changes […] Drink lot of water. Atleast 1.5 to 2.5 liters of water to be consumed in a day. If dizzy, quick gulping of 400-500ml of water will also help to increase blood pressure

• #1 Orthostatic hypotension (postural hypotension) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/orthostatic-hypotension-postural-hypotension

  Orthostatic hypotension also called postural hypotension is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting. […] Treatment for orthostatic hypotension is directed at the cause rather than the low blood pressure itself. For example, if dehydration causes orthostatic hypotension, your health care provider may suggest lifestyle changes such as drinking more water. […] Some simple steps can help manage or prevent orthostatic hypotension. These include: Wearing waist-high compression stockings. These may help improve blood flow and reduce the symptoms of orthostatic hypotension. […] Getting plenty of fluids. Keeping hydrated helps prevent symptoms of low blood pressure. Drink plenty of water before long periods of standing, or any activities that tend to trigger symptoms.

• #1 Orthostatic hypotension (postural hypotension)

  https://www.mymlc.com/health-information/diseases-and-conditions/o/orthostatic-hypotension-postural-hypotension2/

  Get up slowly. You may be able to reduce the dizziness and lightheadedness that occur with orthostatic hypotension by moving slowly from a lying to standing position. Also, when getting out of bed, sit on the edge of your bed for a minute before standing. […] Raise your head in bed. Sleeping with the head of your bed slightly raised can help fight the effects of gravity. […] Move your legs while standing. If you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.

• #1 Orthostatic hypotension: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/orthostatic-hypotension/

  Orthostatic hypotension is a common condition that affects about 6 percent of the population. […] The non-neurogenic form of orthostatic hypotension is often caused by environmental or health factors that impair the body’s mechanisms to stabilize blood pressure upon standing. […] Certain medications can also contribute to non-neurogenic orthostatic hypotension, such as antipsychotic or antidepressant drugs, drugs that treat high blood pressure by widening blood vessels (vasodilators), or drugs that help remove water and salt from the body (diuretics). […] Orthostatic hypotension is a complex condition and is usually not inherited. However, having a close relative with orthostatic hypotension likely increases a person’s risk of developing the condition.

• #1 Evaluation and Management of Orthostatic Hypotension | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html

  Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. […] Goals of treatment involve improving hypotension without excessive supine hypertension, relieving orthostatic symptoms, and improving standing time. […] Nonpharmacologic treatment should be offered to all patients. For patients who do not respond adequately to nonpharmacologic treatment, fludrocortisone, midodrine, and pyridostigmine are pharmacologic therapies proven to be beneficial. […] Patients with chronic orthostatic hypotension should be counseled to avoid large carbohydrate-rich meals, limit alcohol intake, and ensure adequate hydration.

• #1 Evaluation and Management of Orthostatic Hypotension | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html

  Nonpharmacologic treatment should be offered to all patients initially. If potentially contributing medications cannot be discontinued, then patients should be instructed to take them at bedtime when possible, particularly antihypertensives. […] Sodium may be supplemented by adding extra salt to food or taking 0.5- to 1.0-g salt tablets. […] Lower-extremity and abdominal binders may be beneficial. […] An exercise program focused on improving conditioning and teaching physical maneuvers to avoid orthostatic hypotension has proven to be beneficial. […] In patients who do not respond adequately to nonpharmacologic therapy for orthostatic hypotension, medication may be indicated. […] Fludrocortisone, which is a synthetic mineralocorticoid, is considered first-line therapy for the treatment of orthostatic hypotension.

• #1 Evaluation and Management of Orthostatic Hypotension | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html

  Midodrine, a peripheral selective alpha-1-adrenergic agonist, significantly increases standing systolic blood pressure and improves symptoms in patients with neurogenic orthostatic hypotension. […] Pyridostigmine is a cholinesterase inhibitor that improves neurotransmission at acetylcholine-mediated neurons of the autonomic nervous system.

• #1

  https://link.springer.com/article/10.1007/s00702-017-1791-y

  Neurogenic orthostatic hypotension, postprandial hypotension and exercise-induced hypotension are common features of cardiovascular autonomic failure. […] Patients education and non-pharmacological measures remain essential, with strong recommendation for use of abdominal binders. […] In case of severe postprandial hypotension, acarbose and octreotide are recommended (strong recommendation, moderate level of evidence). Alternatively, voglibose or caffeine, for which a weak recommendation is available, may be useful. […] Management of cardiovascular autonomic failure may result challenging in clinical practice, relying on a combination of non-pharmacological and pharmacological measures, in which the underlying etiology, severity of symptoms and the individual risk-benefit ratio need to be taken into account.

• #1 Orthostatic Hypotension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448192/

  Non-pharmacological strategies are tailored to each patient’s triggers and lifestyle, with a combination approach often proving the most effective. […] A high-salt diet of up to 10 grams of salt daily, combined with a liberal water intake of 2 to 3 L/d, has been recommended to promote intravascular expansion. However, this should be carefully balanced with cardiac function parameters and the potential for end-organ damage. […] The management of orthostatic hypotension is most effective when performed by an interprofessional healthcare team that may include endocrinologists, internists, primary care providers, neurologists, advanced practitioners, nurses, pharmacists, social workers, and other healthcare professionals. Treatment strategies are guided by the underlying etiology, with the primary goals being symptom relief and the prevention of associated morbidity.

• #1 An Overview of Orthostatic Hypotension

  https://www.uspharmacist.com/article/an-overview-of-orthostatic-hypotension

  Education and prevention are important components of caring for patients with orthostatic hypotension, and that is where pharmacists should and must play a major role. […] Pharmacists should take a complete medical history to determine if the cause of orthostatic hypotension is drug induced and contact a physician to assist in the selection of alternative treatments, with the goal of minimizing the number of medications that may induce orthostatic hypotension and its complications. […] Orthostatic hypotension is a common cause of increased morbidity and mortality, especially in the elderly population. There are many reversible and nonreversible causes of orthostatic hypotension, both neurogenic and nonneurogenic. Pharmacists have a role in educating patients about both pharmacologic and nonpharmacologic modalities for controlling and preventing the incidence and consequences of orthostatic hypotension.

• #1 Postural Hypotention | Home management and remedies

  https://www.movementdisordersclinic.com/postural-hypotension/

  Avoid alcohol and alcoholic beverages. It adds to BP changes and more symptoms […] Everytime you visit your doctor, show all your prescription and non prescription medications. Some medications may be affecting your postural hypotension. It’s better to get it cross checked on every visit […] Monitor your postural BP changes and maintain a records. This will help your doctor to take decisions on your next visit. Check your BP after sleeping for at least 5 minutes and on standing at 1min, 3min and 5mins.

• #1

  https://link.springer.com/article/10.1007/s40266-020-00796-5

  Orthostatic hypotension (OH) is an abnormal blood pressure response to standing, which is associated with an increased risk of adverse outcomes such as syncope, falls, cognitive impairment, and mortality. […] Consequently, a medication review is recommended as a first-line approach in the diagnostic and therapeutic work-up of OH, with a view to minimizing the risk of drug-related orthostatic blood pressure impairment. […] Given all of the above, medical therapy review and optimization should be routinely included in the diagnostic and therapeutic work-up of OH, along with patients education on lifestyle measures to counteract orthostatic symptoms (e.g., hydration, physical conditioning, use of abdominal binders). […] Therefore, the risk stratification provided in Table 1 may be questionable, somewhat arbitrary, and not supported by strong evidence but mostly by clinical experience and available scientific data. Nevertheless, since our paper aims to be a practical tool for therapy optimization in patients with OH, this risk stratification may be useful to increase awareness on potential causative drugs and to identify priorities in the context of medication review. Withdrawal or reduction of potentially causative medications may reduce drug-related OH and represents a first-line treatment strategy in patients with orthostatic BP impairment.

• #2 Orthostatic Hypotension: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p39.html

  Orthostatic hypotension is defined as a decrease in blood pressure of 20 mm Hg or more systolic or 10 mm Hg or more diastolic within three minutes of standing from the supine position or on assuming a head-up position of 60 degrees during tilt table testing. Symptoms are due to inadequate physiologic compensation and organ hypoperfusion and include headache, lightheadedness, shoulder and neck pain (coat hanger syndrome), visual disturbances, dyspnea, and chest pain. […] Treatment goals for orthostatic hypotension are reducing symptoms and improving quality of life, rather than normalizing blood pressure. […] Nonpharmacologic strategies include dietary modifications, compression garments, physical maneuvers, and avoiding environments that exacerbate symptoms. […] Nonpharmacologic management strategies should be attempted before prescribing a medication. If nonpharmacologic management is insufficient alone, it should be used in combination with medications.

• #2 Preventing and treating orthostatic hypotension: As easy as A, B, C

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2888469/

  The goal of management of orthostatic hypotension is to raise the patients standing blood pressure without also raising his or her supine blood pressure, and specifically to reduce orthostatic symptoms, increase the time the patient can stand, and improve his or her ability to perform daily activities. No specific treatment is currently available that achieves all these goals, and drugs alone are never completely adequate. […] Education is probably the single most important factor in the proper control of orthostatic hypotension. A number of issues should be considered. […] Patients should be taught, in simple terms, the mechanisms that maintain postural normotension and how to recognize the onset of orthostatic symptoms. They must realize that there is no specific treatment of the underlying cause and that drug treatment alone is not adequate. They should be taught nonpharmacologic approaches and be aware that other drugs they start may worsen symptoms.

• #2 What Is Orthostatic Hypotension (Postural Hypotension)?

  https://www.webmd.com/heart/what-is-orthostatic-hypotension-dizzy-standing

  Orthostatic hypotension (also called postural hypotension) is a sudden dip in blood pressure that happens when you stand up after you’ve been sitting or lying down. […] Can You Prevent Orthostatic Hypotension? […] To help keep your balance, stand up slowly. Avoid crossing your legs when you’re sitting for a long time. Don’t stand still in one place; move your feet and legs to help keep your blood flowing. […] Call your doctor if it’s happening regularly or more often, or when it makes you feel faint. Some people may not feel dizzy right away. It could take more than 3 minutes after you stand up. This delayed orthostatic hypotension is a milder form, but a recent study suggests that people who have it may develop more symptoms over time.

• #2 Preventing and treating orthostatic hypotension: As easy as A, B, C

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2888469/

  Maintaining an adequate plasma volume is crucial. Patients should drink five to eight 8-ounce glasses (1.25 to 2.5 L) of water or other fluid per day. […] Appropriate salt supplementation and fluid intake leading to an adequate volume expansion can be verified by checking the 24-hour urinary sodium content: patients who excrete less than 170 mmol can be treated with 1 to 2 g of supplemental sodium three times a day.

• #2

  https://www.healthxchange.sg/high-blood-pressure/essential-guide-to-high-blood-pressure/orthostatic-hypotension-postural-hypotension

  Simple lifestyle changes also helps – Dr Tan advices avoiding prolonged bed rest, and to rise slowly from a lying or sitting position. In addition, avoid drinking alcohol and eating large meals, especially high-carbohydrate meals. Rest after meals. Stay well-hydrated. Avoid hot showers and minimise physical activity, especially in hot weather. I always remind my older patients to wait a while after standing up, before walking off, said Dr Tan.

• #2 Orthostatic hypotension: Causes, symptoms, and prevention

  https://www.medicalnewstoday.com/articles/318158

  Orthostatic hypotension is defined as a sudden drop in blood pressure resulting from a change in posture, such as when a person stands up quickly. […] Low blood pressure does not usually require treatment. If a person experiences regular symptoms of orthostatic hypotension, however, they should see a doctor. […] There are several ways of managing or preventing orthostatic hypotension, most of which do not involve the use of medication. […] Keep hydrated by drinking plenty of fluids. Fluids lost from diarrhea or vomiting should be replaced immediately. Avoid or limit alcohol intake because alcohol can worsen orthostatic hypotension. […] Use more salt in meals. However, consult a doctor first as too much salt in the diet can increase blood pressure. […] Avoid strenuous activity during hot weather.

• #2 Orthostatic hypotension (postural hypotension) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/orthostatic-hypotension-postural-hypotension

  Avoiding alcohol. Alcohol can worsen orthostatic hypotension, so limit or avoid it completely. […] Increasing salt in the diet. This must be done carefully and only after discussing it with a health care provider. Too much salt can cause blood pressure to increase beyond a healthy level, creating new health risks. […] Exercising. Regular cardiovascular and strengthening exercises might help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid weather. […] Getting up slowly. Move slowly from a lying to standing position. Also, when getting out of bed, sit on the edge of the bed for a minute before standing. […] Raising the head of the bed. Sleeping with the head of the bed slightly raised can help fight the effects of gravity.

• #2 Orthostatic hypotension: Causes, symptoms, and prevention

  https://www.medicalnewstoday.com/articles/318158

  When getting out of bed, sit on the edge of the bed for a minute before standing. […] Sleep with the head of your bed slightly elevated. […] Compression stockings can promote circulation and help prevent fluid from pooling in the legs. […] Severe cases of orthostatic hypotension can be treated with drugs to raise blood pressure.

• #2 Orthostatic hypotension – Wikipedia

  https://en.wikipedia.org/wiki/Orthostatic_hypotension

  Various measures can be used to improve the return of blood to the heart; the wearing of compression stockings and exercises („physical counterpressure maneuvers” or PCMs) can be undertaken just before standing up (e.g., leg crossing and squatting), as muscular contraction helps return blood from the legs to the upper body.

• #2 Diagnosis and management of neurogenic orthostatic hypotension

  https://www.e-acn.org/journal/view.php?number=643

  An increase in water and salt intake may expand the intravascular volume and reduce the severity of OH. […] To expand circulating fluid, water intake needs to increase up to 2-2.5 L of water per day. […] Compressive garments for OH include custom-fitted elastic stockings (e.g., waist-high, thigh-high) and abdominal binder. […] Activities such as prolonged standing, alcohol consumption, hot showers, and saunas should be avoided as they augment vasodilation and venous pooling. […] A stepwise approach is recommended to manage N-OH symptoms. […] It is important to consider combined medical conditions and correct potential contributors to OH. […] Before initiating pharmacological treatment, non-pharmacological approaches should be explored and tailored to the patients situation.

• #2 Orthostatic Hypotension (Postural Hypotension)

  https://my.clevelandclinic.org/health/diseases/9385-low-blood-pressure-orthostatic-hypotension

  Orthostatic hypotension (also called postural hypotension) is a condition in which your blood pressure quickly drops when you stand up after sitting or lying down. […] Symptoms usually improve when you change your medications or move into an upright position more slowly. […] If youre prone to orthostatic hypotension, these steps can reduce symptoms: Keep your temperature moderate: Dont take very hot baths or showers. Stay hydrated: Drink plenty of water, limit alcohol and avoid heavy, high-carbohydrate meals. Dont sleep flat: Elevate your head at night by using more pillows or tilting the mattress. Prepare before standing: Give yourself more time to move into a standing position after sitting or lying down. Have something sturdy nearby to hold onto when you stand up. Move your muscles: March your feet if you must stand for prolonged periods. Do isometric exercises (squeeze a soft rubber ball or towel, or clench and unclench your hands) to raise blood pressure before standing. Improve blood circulation and pressure: Wear compression stockings or an abdominal binder (elastic that compresses your abdomen). […] Most people with orthostatic hypotension can manage symptoms by taking preventive steps. For example, you may need to move more slowly into a standing position. The condition rarely causes long-term problems.

• #2

  https://link.springer.com/article/10.1007/s40266-020-00796-5

  Orthostatic hypotension (OH) is an abnormal blood pressure response to standing, which is associated with an increased risk of adverse outcomes such as syncope, falls, cognitive impairment, and mortality. […] Consequently, a medication review is recommended as a first-line approach in the diagnostic and therapeutic work-up of OH, with a view to minimizing the risk of drug-related orthostatic blood pressure impairment. […] Given all of the above, medical therapy review and optimization should be routinely included in the diagnostic and therapeutic work-up of OH, along with patients education on lifestyle measures to counteract orthostatic symptoms (e.g., hydration, physical conditioning, use of abdominal binders). […] Therefore, the risk stratification provided in Table 1 may be questionable, somewhat arbitrary, and not supported by strong evidence but mostly by clinical experience and available scientific data. Nevertheless, since our paper aims to be a practical tool for therapy optimization in patients with OH, this risk stratification may be useful to increase awareness on potential causative drugs and to identify priorities in the context of medication review. Withdrawal or reduction of potentially causative medications may reduce drug-related OH and represents a first-line treatment strategy in patients with orthostatic BP impairment.

• #2 Evaluation and Management of Orthostatic Hypotension | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html

  Nonpharmacologic treatment should be offered to all patients initially. If potentially contributing medications cannot be discontinued, then patients should be instructed to take them at bedtime when possible, particularly antihypertensives. […] Sodium may be supplemented by adding extra salt to food or taking 0.5- to 1.0-g salt tablets. […] Lower-extremity and abdominal binders may be beneficial. […] An exercise program focused on improving conditioning and teaching physical maneuvers to avoid orthostatic hypotension has proven to be beneficial. […] In patients who do not respond adequately to nonpharmacologic therapy for orthostatic hypotension, medication may be indicated. […] Fludrocortisone, which is a synthetic mineralocorticoid, is considered first-line therapy for the treatment of orthostatic hypotension.

• #2 Intervention and alternatives | Postural hypotension in adults: fludrocortisone | Advice | NICE

  https://www.nice.org.uk/advice/esuom20/chapter/intervention-and-alternatives

  This evidence summary addresses the use of oral fludrocortisone acetate tablets (Florinef; E.R. Squibb Sons) for treating postural hypotension in adults. […] Fludrocortisone is a synthetic mineralocorticoid that acts by increasing plasma volume as a result of its sodium-retaining effects, thus increasing cardiac output. […] Postural hypotension may be idiopathic or may arise as a result of disorders affecting the autonomic nervous system (for example, Parkinson’s disease, multiple system atrophy or diabetic autonomic neuropathy), from a loss of blood volume or dehydration, or because of certain medications such as antihypertensives (Gibbons et al. 2010). […] NICE guidance on transient loss of consciousness in adults and young people advises that, if postural hypotension is suspected after an initial assessment, when the history is typical and there are no features suggesting an alternative diagnosis, then the person should have their blood pressure measured lying and standing (with repeated measurements while standing for 3 minutes).

• #2 Orthostatic hypotension – Wikipedia

  https://en.wikipedia.org/wiki/Orthostatic_hypotension

  Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person’s blood pressure drops when they are standing up (orthostasis) or sitting down. […] Apart from addressing the underlying cause, orthostatic hypotension may be treated with a recommendation to increase salt and water intake (to increase the blood volume), wearing compression stockings, and sometimes medication (fludrocortisone, midodrine, or others). […] Apart from treating underlying reversible causes (e.g., stopping or reducing certain medications, treating autoimmune causes), several measures can improve the symptoms of orthostatic hypotension and prevent episodes of syncope (fainting). […] The medication midodrine, an 1-adrenergic receptor agonist, can benefit people with orthostatic hypotension.

• #2 Intervention and alternatives | Postural hypotension in adults: fludrocortisone | Advice | NICE

  https://www.nice.org.uk/advice/esuom20/chapter/intervention-and-alternatives

  A number of drug and non-pharmacological approaches have been used to treat postural hypotension (Logan and Witham 2012). Non-pharmacological treatments include increasing water and salt intake, or using compression garments or bandages and physical manoeuvres to counter the drop in blood pressure (Gibbons et al. 2010; Logan and Witham 2012). […] There are no drugs with marketing authorisation for use in postural hypotension in the UK. Many drugs have been considered or studied for potential use in postural hypotension, including drugs that target the autonomic nervous system (such as midodrine, phenylephrine, ephedrine, pseudoephedrine, droxidopa and phenylpropanolamine), pyridostigmine, domperidone, non-steroidal anti-inflammatory drugs and erythropoietin (Gibbons et al. 2010; Logan and Witham 2012).

• #2

  https://link.springer.com/article/10.1007/s00702-017-1791-y

  Non-pharmacological treatment options remain pivotal for the treatment of autonomic failure. […] Conservative interventions include adequate fluid (1.52 l/day) and salt (610 g/day) intake, as well as abdominal binders, alone or in combination with compression stockings to reduce venous pooling. […] When aforementioned measures have been implemented and do not provide satisfactory relief, pharmacological therapy is required in addition. […] At present only midodrine and droxidopa (the latter in the US and Japan only) have been approved for treatment of nOH, while the remaining substances are prescribed in an off-label regimen. […] In severe postprandial hypotension with limited response to conservative management (avoidance of large fat- or carbohydrate-rich meals and alcohol, increase in fluid and salt intake), acarbose in a dosage of 100 mg can be used in selected cases (quality of evidence is moderate, recommendation strong).

• #2 Syndrome of Supine Hypertension with Orthostatic Hypotension. A Nightmare for Physicians

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2016/march/830-syndrome-of-supine-hypertension

  Orthostatic hypotension (OH) is a condition that is relatively common in elderly patients and those who suffer from diabetes mellitus and Parkinson’s disease. […] The treatment of SH/OH can be very challenging for the physician. This is partly because the etiology of the syndrome can be difficult to delineate. Additionally, patients can have very different responses to standard therapy, so outcomes can vary greatly from case to case. […] Sharabi and Goldstein have suggested that OH and SH should be treated separately, and that non-pharmacological interventions should be employed first. For OH, these include smaller, more frequent meals and increasing water intake, along with other physical maneuvers to increase blood pressure (such as squatting). […] The treatment of OH should be aimed more at improving quality of life and prevention of injury, and the treatment of SH is primarily aimed at decreasing organ damage. […] Further research should help us secure a better appreciation of this condition while at the same time elaborating better therapeutic modalities.

• #2 Dizziness – orthostatic hypotension | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dizziness-orthostatic-hypotension

  Orthostatic hypotension is a form of low blood pressure caused by blood vessels failing to constrict when the body takes an upright position. […] The incidence of orthostatic hypotension increases with age. […] Treatment depends on the cause. Options may include: […] Be guided by your doctor, but general suggestions that may help you to manage orthostatic hypotension include: […] Get up slowly from a sitting or lying position to allow your blood vessels time to adjust. […] Wear support stockings to reduce the pooling of blood in the legs, which helps to boost blood pressure throughout the body. […] Drink plenty of fluids throughout the day to prevent dehydration. […] Limit alcohol consumption. Alcohol can cause dehydration and dilation of blood vessels. […] Avoid standing without moving for long periods of time. […] See your doctor for regular blood pressure check-ups.

• #2 Preventing and treating orthostatic hypotension: As easy as A, B, C | MDedge

  https://www.mdedge.com/content/preventing-and-treating-orthostatic-hypotension-easy-b-c

  Orthostatic hypotension is a chronic, debilitating illness that is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and function rather than to achieve upright normotension, which can lead to supine hypertension. Drug therapy alone is never adequate. Because orthostatic stress varies with circumstances during the day, a patient-oriented approach that emphasizes education and nonpharmacologic strategies is critical. We provide easy-to-remember management recommendations, using a combination of drug and nondrug treatments that have proven efficacious. […] Treatment is directed at increasing blood volume, decreasing venous pooling, and increasing vasoconstriction while minimizing supine hypertension. Patient education and nondrug strategies alone can be effective in mild cases. Examples: consuming extra fluids and salt, wearing an abdominal binder, drinking boluses of water, raising the head of the bed, and performing countermaneuvers and physical activity.

• #2

  https://link.springer.com/article/10.1007/s40266-020-00796-5

  Specific drug treatment for OH may be considered if symptoms persist despite non-pharmacological measures. Health care professionals should thus be educated to optimize medical therapy in subjects with OH, in the context of a comprehensive assessment of clinical status and preferences of individual patients.

• #3 Evaluation and Management of Orthostatic Hypotension | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html

  Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. […] Goals of treatment involve improving hypotension without excessive supine hypertension, relieving orthostatic symptoms, and improving standing time. […] Nonpharmacologic treatment should be offered to all patients. For patients who do not respond adequately to nonpharmacologic treatment, fludrocortisone, midodrine, and pyridostigmine are pharmacologic therapies proven to be beneficial. […] Patients with chronic orthostatic hypotension should be counseled to avoid large carbohydrate-rich meals, limit alcohol intake, and ensure adequate hydration.

• #3 Orthostatic Hypotension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448192/

  Orthostatic hypotension, also known as postural hypotension, is defined as a sudden drop in blood pressure that occurs upon standing from a sitting or supine position. This condition significantly impacts quality of life and increases the risk of falls, cardiovascular disease, dementia, depression, and mortality. […] Treatment focuses on identifying the underlying cause of orthostatic hypotension and implementing tailored behavioral modifications. In addition, pharmacological options may be considered based on the underlying pathology if these interventions prove ineffective. […] Non-pharmacological treatments focus on restoring a patient’s functional status and improving their ability to perform daily activities rather than targeting a specific blood pressure level. Education is crucial in helping patients create a personalized treatment plan based on their daily routines. Key aspects of education should include recognizing the warning signs of orthostatic hypotension episodes and identifying triggers such as prolonged standing, large meals, dehydration, alcohol consumption, hot environments, and hot baths or showers.

• #3 Orthostatic Hypotension (Postural Hypotension)

  https://my.clevelandclinic.org/health/diseases/9385-low-blood-pressure-orthostatic-hypotension

  Orthostatic hypotension (also called postural hypotension) is a condition in which your blood pressure quickly drops when you stand up after sitting or lying down. […] Symptoms usually improve when you change your medications or move into an upright position more slowly. […] If youre prone to orthostatic hypotension, these steps can reduce symptoms: Keep your temperature moderate: Dont take very hot baths or showers. Stay hydrated: Drink plenty of water, limit alcohol and avoid heavy, high-carbohydrate meals. Dont sleep flat: Elevate your head at night by using more pillows or tilting the mattress. Prepare before standing: Give yourself more time to move into a standing position after sitting or lying down. Have something sturdy nearby to hold onto when you stand up. Move your muscles: March your feet if you must stand for prolonged periods. Do isometric exercises (squeeze a soft rubber ball or towel, or clench and unclench your hands) to raise blood pressure before standing. Improve blood circulation and pressure: Wear compression stockings or an abdominal binder (elastic that compresses your abdomen). […] Most people with orthostatic hypotension can manage symptoms by taking preventive steps. For example, you may need to move more slowly into a standing position. The condition rarely causes long-term problems.

• #3 Evaluation and Management of Orthostatic Hypotension | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html

  Nonpharmacologic treatment should be offered to all patients initially. If potentially contributing medications cannot be discontinued, then patients should be instructed to take them at bedtime when possible, particularly antihypertensives. […] Sodium may be supplemented by adding extra salt to food or taking 0.5- to 1.0-g salt tablets. […] Lower-extremity and abdominal binders may be beneficial. […] An exercise program focused on improving conditioning and teaching physical maneuvers to avoid orthostatic hypotension has proven to be beneficial. […] In patients who do not respond adequately to nonpharmacologic therapy for orthostatic hypotension, medication may be indicated. […] Fludrocortisone, which is a synthetic mineralocorticoid, is considered first-line therapy for the treatment of orthostatic hypotension.

• #3 Orthostatic Hypotension: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.orthostatic-hypotension-care-instructions.uf8707

  Orthostatic hypotension is a quick drop in blood pressure. It happens when you get up from sitting or lying down. You may feel faint, lightheaded, or dizzy. […] Follow your doctor’s suggestions for ways to prevent symptoms like dizziness. These suggestions may include: Get up slowly from bed or after sitting for a long time. If you are in bed, roll to your side and swing your legs over the edge of the bed and onto the floor. Push your body up to a sitting position. Wait for a while before you slowly stand up. […] Add more salt to your diet, if your doctor recommends it. […] Drink plenty of fluids. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink. […] Avoid or limit alcohol to 2 drinks a day for men and 1 drink a day for women. Alcohol may interfere with your medicine. In addition, alcohol can make your low blood pressure worse by causing your body to lose water. […] Wear compression stockings to help improve blood flow.

• #3 Orthostatic Hypotension: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p39.html

  Initiating lifestyle-based treatments, such as avoiding or modifying exacerbating activities, is the first-line approach for the management of neurogenic orthostatic hypotension. […] Appropriate volume status is maintained by adequate hydration and sodium intake. […] Physical counter maneuvers, including leg-crossing or squatting, in addition to wearing waist-high compression garments with graded pressures of 30 to 40 mm Hg, may be used to reduce venous pooling in the legs and splanchnic circulation. […] Elevating the head of the bed by 30 to 45 degrees at night can theoretically prevent supine hypertension, which exacerbates morning orthostatic hypotension by promoting nocturnal diuresis and natriuresis.

• #3

  https://www.healthxchange.sg/high-blood-pressure/essential-guide-to-high-blood-pressure/orthostatic-hypotension-postural-hypotension

  Simple lifestyle changes also helps – Dr Tan advices avoiding prolonged bed rest, and to rise slowly from a lying or sitting position. In addition, avoid drinking alcohol and eating large meals, especially high-carbohydrate meals. Rest after meals. Stay well-hydrated. Avoid hot showers and minimise physical activity, especially in hot weather. I always remind my older patients to wait a while after standing up, before walking off, said Dr Tan.

• #3 Diagnosis and management of neurogenic orthostatic hypotension

  https://www.e-acn.org/journal/view.php?number=643

  Orthostatic hypotension is a sustained and pathological drop in blood pressure upon standing. […] For the management of neurogenic orthostatic hypotension, physicians should implement non-pharmacological methods and, if possible, reverse combined non-neurological conditions. […] Its management should be individualized based on intensity of symptoms, comorbid conditions, drug side effects, and etiology. […] In milder cases, pharmacological agents can be used when non-pharmacological treatments are insufficient. […] But, in severe cases, both non-pharmacological and pharmacological measures may need to be started spontaneously. […] Physical counter-maneuvers such as squatting, leg-crossing, thigh contraction, and bending at the waist can reduce venous pooling and increase total peripheral resistance quickly through mechanical compression of the vein.

• #3 Postural hypotension (low blood pressure when you stand up) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/postural-hypotension

  Postural hypotension (also called orthostatic hypotension) is a drop in blood pressure when you stand up after lying or sitting down. This can make you feel dizzy and can even cause you to faint. […] If you have postural hypotension, there are some things that you can do to help your symptoms. […] Drinking more fluids but less caffeine might reduce the symptoms of postural hypotension. […] Some blood pressure medicines can make you more likely to get postural hypotension. A GP can review your medicines and change them if needed. […] A medicine called fludrocortisone can increase your blood pressure and reduce the effects of postural hypotension. […] Take your time when you stand up. Sit down again if you feel dizzy. […] Postural hypotension makes you more likely to have a fall. […] We have information on how to prevent falls and get support.

• #3

  https://link.springer.com/article/10.1007/s00702-017-1791-y

  Non-pharmacological treatment options remain pivotal for the treatment of autonomic failure. […] Conservative interventions include adequate fluid (1.52 l/day) and salt (610 g/day) intake, as well as abdominal binders, alone or in combination with compression stockings to reduce venous pooling. […] When aforementioned measures have been implemented and do not provide satisfactory relief, pharmacological therapy is required in addition. […] At present only midodrine and droxidopa (the latter in the US and Japan only) have been approved for treatment of nOH, while the remaining substances are prescribed in an off-label regimen. […] In severe postprandial hypotension with limited response to conservative management (avoidance of large fat- or carbohydrate-rich meals and alcohol, increase in fluid and salt intake), acarbose in a dosage of 100 mg can be used in selected cases (quality of evidence is moderate, recommendation strong).

• #3 Hypotension (Low Blood Pressure): Causes, Symptoms, and Treatment

  https://patient.info/doctor/hypotension

  Orthostatic hypotension is defined as a sustained reduction in systolic blood pressure of at least 20 mm Hg or a reduction in diastolic blood pressure of at least 10 mm Hg, usually within the first three minutes of standing or head-up tilt on a tilt table. […] Orthostatic hypotension increases the risk of falls, cardiovascular disease, and all-cause mortality. […] The initial treatment approach to postprandial hypotension is non-pharmacological. Patients with postprandial hypotension should be advised to take in smaller more frequent meals. […] The key to managing postural hypotension is individually tailored therapy. The goal of treatment is to improve the patient’s functional capacity and quality of life, preventing injury, rather than to achieve a target BP. […] Many patients will improve with simple measures and these should be tried first: The patient (and carers) should be educated about the various factors that affect BP and about the special aspects that have to be avoided – eg, foods, habits, positions and drugs. […] If hypotension symptoms still persist, consider medication. Medications used for orthostatic hypotension include midodrine, fludrocortisone, droxidopa, octreotide and pyridostigmine.

• #3 Incidence of postural hypotension recorded in UK general practice: an electronic health records study | British Journal of General Practice

  https://bjgp.org/content/73/726/e9

  Postural hypotension is a common condition associated with adverse outcomes in older adults. General practice plays an important role in identification of the condition. […] Early detection in patients who are symptomatic or in those with certain risk factors may prevent some of these complications. General practice plays an important role in identification; however, current guidelines for detecting postural hypotension are varied and based on limited evidence. […] Standardised recording of postural BP may help increase identification and recording of postural hypotension in GP records. […] Early identification of postural hypotension (that is, before the onset of clinical sequelae such as falls and ischaemic events) may allow for a window of opportunity. This can be used to adjust high-risk drugs, optimise CVD status, and provide practical advice on hydration that may reduce subsequent adverse outcomes.

• #3 Preventing and treating orthostatic hypotension: As easy as A, B, C | MDedge

  https://www.mdedge.com/content/preventing-and-treating-orthostatic-hypotension-easy-b-c

  This review focuses on the prevention and treatment of neurogenic causes of orthostatic hypotension. We emphasize a simple but effective patient-oriented approach to management, using a combination of nonpharmacologic strategies and drugs clinically proven to be efficacious. The recommendations and their rationale are organized in a practical and easy-to-remember format for both physicians and patients.

• #4 Postural hypotension – GPnotebook

  https://gpnotebook.com/pages/cardiovascular-medicine/postural-hypotension

  Orthostatic hypotension (OH) or postural hypotension occurs when mechanisms for the regulation of orthostatic BP control fail. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. […] Treatment of OH – management and prognosis vary according to the underlying cause, with the main distinction being whether orthostatic hypotension is neurogenic or non-neurogenic. […] Practical goal is to improve standing BP so as to minimize symptoms and to improve standing time in order to be able to undertake orthostatic activities of daily living, without excessive supine hypertension. […] NICE state: in people with symptoms of postural hypotension, including falls or postural dizziness: measure blood pressure with the person lying on their back (or consider a seated position, if it is inconvenient to measure blood pressure with the person lying down).

• #4 Postural Hypotention | Home management and remedies

  https://www.movementdisordersclinic.com/postural-hypotension/

  Avoid sudden position changes. Take time to move from one position to other, especially from sleeping and sitting position. Move your legs like marching or cycling for few seconds before you get up […] Keeping your head end of the bed elevated will help to some extent to avoid sudden blood pressure changes […] Avoid large / big meals. Take small quantity and more frequent meals. Suggestions would be to have small meals/snacks once in 3-4 hours. […] Avoid very hot water bath. Hot water bath affects the blood flow pattern, leading to BP fluctuations. […] Use abdominal binders and compression stockings. This will help to reduce the blood pressure drop during sudden posture changes […] Drink lot of water. Atleast 1.5 to 2.5 liters of water to be consumed in a day. If dizzy, quick gulping of 400-500ml of water will also help to increase blood pressure

• #4 Orthostatic Hypotension – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/orthostatic-hypotension

  Waist-high fitted elastic hose may increase venous return, cardiac output, and BP after standing. In severe cases, inflatable aviator-type antigravity suits, although often poorly tolerated, may be needed to produce adequate leg and abdominal counterpressure. […] Increasing sodium and water intake may expand intravascular volume and lessen symptoms. In the absence of heart failure or hypertension, sodium intake can be increased to 6 to 10 g daily by liberally salting food or taking sodium chloride tablets. This approach risks heart failure, particularly in older patients and in patients with impaired myocardial function; development of dependent edema without heart failure does not contraindicate continuing this approach.

• #4 Postural (Orthostatic) Hypotension

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Condition_Orthostatic_Hypotension_-_Cardiology.xml?co=/regions/mas

  Postural (orthostatic) hypotension is when a person’s blood pressure (BP) drops significantly when they stand up from sitting or lying down. Especially after standing up quickly, the person may feel dizzy or faint for a few seconds. […] Treatment depends on what’s causing your postural hypotension. We also treat related medical conditions, if any. […] We talk about lifestyle changes that can help reduce your symptoms. […] You can use these tips to help reduce postural hypotension symptoms. […] Stand up slowly. […] Wear compression stockings. […] Strengthen your calf muscles. […] Stay hydrated. […] Eat more salt (sodium). […] Sit up often if on bedrest. […] Don’t cross your legs when sitting. […] Eat smaller meals.

• #4 Dizziness – orthostatic hypotension | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dizziness-orthostatic-hypotension

  Orthostatic hypotension is a form of low blood pressure caused by blood vessels failing to constrict when the body takes an upright position. […] The incidence of orthostatic hypotension increases with age. […] Treatment depends on the cause. Options may include: […] Be guided by your doctor, but general suggestions that may help you to manage orthostatic hypotension include: […] Get up slowly from a sitting or lying position to allow your blood vessels time to adjust. […] Wear support stockings to reduce the pooling of blood in the legs, which helps to boost blood pressure throughout the body. […] Drink plenty of fluids throughout the day to prevent dehydration. […] Limit alcohol consumption. Alcohol can cause dehydration and dilation of blood vessels. […] Avoid standing without moving for long periods of time. […] See your doctor for regular blood pressure check-ups.

• #4 Orthostatic Hypotension – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/orthostatic-hypotension

  Orthostatic hypotension typically involves volume depletion or autonomic dysfunction. […] Treatment involves physical measures to reduce venous pooling, increased sodium intake, and sometimes fludrocortisone or midodrine. […] Patients requiring prolonged bed rest should sit up each day and exercise in bed when possible. Patients should rise slowly from a recumbent or sitting position, consume adequate fluids, limit or avoid alcohol, and exercise regularly when feasible. Regular modest-intensity exercise promotes overall vascular tone and reduces venous pooling. Older patients should avoid prolonged standing. Sleeping with the head of the bed raised may relieve symptoms by promoting sodium retention and reducing nocturnal diuresis. […] Postprandial hypotension can often be prevented by reducing the size and carbohydrate content of meals, minimizing alcohol intake, and avoiding sudden standing after meals.

• #4 Orthostatic hypotension (postural hypotension) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/orthostatic-hypotension-postural-hypotension

  Avoiding alcohol. Alcohol can worsen orthostatic hypotension, so limit or avoid it completely. […] Increasing salt in the diet. This must be done carefully and only after discussing it with a health care provider. Too much salt can cause blood pressure to increase beyond a healthy level, creating new health risks. […] Exercising. Regular cardiovascular and strengthening exercises might help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid weather. […] Getting up slowly. Move slowly from a lying to standing position. Also, when getting out of bed, sit on the edge of the bed for a minute before standing. […] Raising the head of the bed. Sleeping with the head of the bed slightly raised can help fight the effects of gravity.

• #4 An Overview of Orthostatic Hypotension

  https://www.uspharmacist.com/article/an-overview-of-orthostatic-hypotension

  Patients should be encouraged to change position slowly. When rising from a supine position, patients should be encouraged to sit on the side of the bed for a few minutes before standing up. […] Additionally, adequate fluid intake should be maintained to prevent dehydration and to improve the symptoms of orthostatic hypotension. […] Individuals experiencing postprandial orthostatic hypotension due to gastrointestinal and hepatic pooling should be counseled to eat more frequent, smaller meals and to plan on a 60-minute postprandial resting period. […] Patients should be advised to avoid hot showers or exercising in warm environments. […] All of these nonpharmacologic treatment strategies minimize the impact of postural orthostatic hypotension on activities of daily living. […] Pharmacologic treatment is aimed at increasing central plasma volume and preventing plasma pooling. A number of agents have been studied for this purpose.

• #4 Preventing and treating orthostatic hypotension: As easy as A, B, C | MDedge

  https://www.mdedge.com/content/preventing-and-treating-orthostatic-hypotension-easy-b-c

  Orthostatic hypotension is a chronic, debilitating illness that is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and function rather than to achieve upright normotension, which can lead to supine hypertension. Drug therapy alone is never adequate. Because orthostatic stress varies with circumstances during the day, a patient-oriented approach that emphasizes education and nonpharmacologic strategies is critical. We provide easy-to-remember management recommendations, using a combination of drug and nondrug treatments that have proven efficacious. […] Treatment is directed at increasing blood volume, decreasing venous pooling, and increasing vasoconstriction while minimizing supine hypertension. Patient education and nondrug strategies alone can be effective in mild cases. Examples: consuming extra fluids and salt, wearing an abdominal binder, drinking boluses of water, raising the head of the bed, and performing countermaneuvers and physical activity.

• #4 Postural hypotension (low blood pressure when you stand up) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/postural-hypotension

  Postural hypotension (also called orthostatic hypotension) is a drop in blood pressure when you stand up after lying or sitting down. This can make you feel dizzy and can even cause you to faint. […] If you have postural hypotension, there are some things that you can do to help your symptoms. […] Drinking more fluids but less caffeine might reduce the symptoms of postural hypotension. […] Some blood pressure medicines can make you more likely to get postural hypotension. A GP can review your medicines and change them if needed. […] A medicine called fludrocortisone can increase your blood pressure and reduce the effects of postural hypotension. […] Take your time when you stand up. Sit down again if you feel dizzy. […] Postural hypotension makes you more likely to have a fall. […] We have information on how to prevent falls and get support.

• #4 Orthostatic hypotension – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/972

  Orthostatic hypotension (OH) is an independent predictor of mortality and the cause of significant morbidity associated with falls. […] A common problem in frail older people. OH-related hospitalisations increase markedly with age. […] Treatment consists of addressing any underlying pathology, when possible, followed by discontinuing or reducing the dose of aggravating drugs, and introducing non-pharmacological countermeasures (e.g., liberalisation of salt intake, use of abdominal binders or compression stockings). […] Volume expansion (using mineralocorticoid therapy) may be used after these therapies due to limited evidence for its use, and a number of undesirable adverse effects. […] This topic concentrates on OH caused by autonomic problems. […] Risk factors include older adult age, frailty and physical deconditioning, use of drugs that impair sympathetic tone, volume depletion/anaemia, autonomic neuropathy (e.g., diabetes mellitus), Parkinson’s disease, dementia with Lewy bodies, multiple system atrophy, and hypertension.

• #4 Hypotension (Low Blood Pressure): Causes, Symptoms, and Treatment

  https://patient.info/doctor/hypotension

  Orthostatic hypotension is defined as a sustained reduction in systolic blood pressure of at least 20 mm Hg or a reduction in diastolic blood pressure of at least 10 mm Hg, usually within the first three minutes of standing or head-up tilt on a tilt table. […] Orthostatic hypotension increases the risk of falls, cardiovascular disease, and all-cause mortality. […] The initial treatment approach to postprandial hypotension is non-pharmacological. Patients with postprandial hypotension should be advised to take in smaller more frequent meals. […] The key to managing postural hypotension is individually tailored therapy. The goal of treatment is to improve the patient’s functional capacity and quality of life, preventing injury, rather than to achieve a target BP. […] Many patients will improve with simple measures and these should be tried first: The patient (and carers) should be educated about the various factors that affect BP and about the special aspects that have to be avoided – eg, foods, habits, positions and drugs. […] If hypotension symptoms still persist, consider medication. Medications used for orthostatic hypotension include midodrine, fludrocortisone, droxidopa, octreotide and pyridostigmine.

• #4 Incidence of postural hypotension recorded in UK general practice: an electronic health records study | British Journal of General Practice

  https://bjgp.org/content/73/726/e9

  Future research should consider age-sex interactions, with greater differences in rates of postural hypotension among males and females in older age groups (70 years). This study provides context for future research to investigate the potential benefits of routine screening of postural BP in general practice among high-risk patients.

• #5 Low blood pressure (hypotension)

  https://www.nhs.uk/conditions/low-blood-pressure-hypotension/

  If you get symptoms when you stand up or suddenly change position, you may have a type of low blood pressure called postural hypotension. […] There are things you can do to help with symptoms of low blood pressure. […] get up slowly from sitting to standing […] take care when getting out of bed move slowly from lying to sitting to standing […] do not bend down or change posture suddenly.

• #5 Low Blood Pressure and PD | Parkinson’s Foundation

  https://www.parkinson.org/library/fact-sheets/blood-pressure

  Orthostatic hypotension (OH) is a form of low blood pressure that happens when standing after sitting or lying down. […] This type of low blood pressure caused by a change in position is called orthostatic hypotension (OH). When it is related to a nervous system disease, like Parkinsons, it is also referred to as neurogenic orthostatic hypotension (nOH). […] Recognizing the signs of OH is key to developing strategies to prevent falls, which can result in serious injuries. Stay hydrated by drinking fluids, especially during hot-weather months. Also, when getting out of bed or standing up from a chair, move slowly to give your body time to adjust. […] Talk to your doctor about medications that can help you reduce OH symptoms. Be aware that medications that raise low blood pressure to normal levels when a person is standing may cause high blood pressure when a person is lying down. There may be additional side effects to discuss with your doctor. […] If you expect to be standing for a long period of time, drinking two 8-ounce glasses of cold water quickly will increase blood volume and blood pressure will go up.

• #5 Orthostatic hypotension (postural hypotension) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/orthostatic-hypotension-postural-hypotension

  Avoiding alcohol. Alcohol can worsen orthostatic hypotension, so limit or avoid it completely. […] Increasing salt in the diet. This must be done carefully and only after discussing it with a health care provider. Too much salt can cause blood pressure to increase beyond a healthy level, creating new health risks. […] Exercising. Regular cardiovascular and strengthening exercises might help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid weather. […] Getting up slowly. Move slowly from a lying to standing position. Also, when getting out of bed, sit on the edge of the bed for a minute before standing. […] Raising the head of the bed. Sleeping with the head of the bed slightly raised can help fight the effects of gravity.

• #5 Progressive orthostatic hypotension in the elderly

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-5/Progressive-orthostatic-hypotension-in-the-elderly-Title-Progressive-orthosta

  Progressive orthostatic hypotension is characterised by a slow progressive decrease in systolic blood pressure upon the assumption of a standing position. […] Home treatment based on self administered elastic leg stockings seems feasible, safe and well accepted by most patients. […] To conclude, lower limb compression bandaging is effective in avoiding orthostatic systolic blood fall and reducing symptoms in elderly patients affected by progressive orthostatic hypotension. Home treatment based on self administered elastic leg stockings seems feasible, safe and well accepted by most patients. If the efficacy of the therapy is confirmed in a larger controlled follow-up study, elastic compression stockings may become a widely used therapy.

• #6 Orthostatic Hypotension – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/orthostatic-hypotension

  Waist-high fitted elastic hose may increase venous return, cardiac output, and BP after standing. In severe cases, inflatable aviator-type antigravity suits, although often poorly tolerated, may be needed to produce adequate leg and abdominal counterpressure. […] Increasing sodium and water intake may expand intravascular volume and lessen symptoms. In the absence of heart failure or hypertension, sodium intake can be increased to 6 to 10 g daily by liberally salting food or taking sodium chloride tablets. This approach risks heart failure, particularly in older patients and in patients with impaired myocardial function; development of dependent edema without heart failure does not contraindicate continuing this approach.

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