Causes and risk factors
The autonomic nervous system and cardiovascular system is responsible for making changes in blood pressure and heart rate when there is change in position, so as to provide adequate blood supply to brain. On standing, there is sudden pooling of blood into the extremities and splanchnic circulation. It increases sympathetic outflow, with increase in peripheral vascular resistance, venous return, cardiac output thus preventing drop in blood pressure. But, in orthostatic hypotension, due to sudden change in position, this mechanism is hampered due to decreased peripheral vascular resistance, decreased venous return, and inability to increase cardiac output. Orthostatic hypotension can be acute or chronic; symptomatic or asymptomatic. Sudden change in position is the main cause of orthostatic hypotension. Other causes include dehydration, blood loss, and anaemia. Disorders like endocrine diseases, heart diseases, nervous system disorders, vasovagal syncope can lead to this condition. Medications like diuretics, anti hypertensive can cause orthostatic hypotension. In some people, this condition is caused after meals especially in elderly people called as postprandial hypotension.
Clinical presentation
Patient experiences light headedness, blurry vision, confusion, lack of concentration. There is sleepiness, dizziness, weakness, fainting [syncope]. There may be nausea and increased thirst. Patient has cold, clammy, pale skin. Patient can have rapid, shallow breathing, profuse sweating.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Blood pressure is monitored. Pulse rate or heart rate, respiratory rate is measured. ECG, 2D echo is recommended. Routine blood tests are done. Stress test, head up tilt test are advised. Valsalva’s manoeuvre is useful for checking the function of autonomic nervous system.
Treatment
In many cases if the low blood pressure is not causing any symptoms then the person need not require any treatment. Treatment of hypotension depends on the cause and symptoms. Home care is advised i.e. If blood pressure drops suddenly, sit or lie down, and raise your feet above heart level. If hypotension is caused by dehydration, doctor may suggest drinking more fluids. Other changes in lifestyle include, use of compression stockings, regular exercise, healthy diet, dinking plenty of liquids, quit smoking, alcohol, or tobacco, and increasing salt in the diet will also help in managing Orthostatic hypotension.
Other Modes of treatment
The other modes of treatment can also be effective in treating Orthostatic hypotension.
Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating orthostatic hypotension.
