Orthostatic hypotension (Smarty PANCE)

What is orthostatic hypotension?

Orthostatic hypotension is an excessive fall in BP when an upright position is assumed.

What is the accepted definition of orthostatic hypotension?

The accepted definition is a drop of ≥ 20 mm Hg systolic, ≥ 10 mmHg diastolic, or both within 3 minutes after a change from supine to standing

Symptoms of orthostatic hypotension?

Symptoms include faintness, light-headedness, dizziness, confusion, or blurred vision that occur within seconds to a few minutes of standing and resolve rapidly on lying down. Some patients experience falls, syncope, or even generalized seizures

What are the most common causes of acute orthostatic hypotension?

The most common causes of acute orthostatic hypotension include

● Hypovolemia

● Drugs

● Prolonged bed rest

● Adrenal insufficiency

What are the most common causes of chronic orthostatic hypotension?

The most common causes of chronic orthostatic hypotension include

● Age-related changes in BP regulation

● Drugs

● Autonomic dysfunction

Diagnosis of orthostatic hypotension?

BP and heart rate are measured after 5 min supine and at 1 and 3 min after standing; patients unable to stand may be assessed while sitting upright.

Hypotension without a compensatory increase in heart rate (< 10 beats/min) suggests what?

Autonomic impairment

What test may be done when autonomic dysfunction is suspected?

Tilt table testing may be done when autonomic dysfunction is suspected

Marked increase in pulse with hypotension (to > 100 beats/min or by > 30 beats/min) suggests what?

Hypovolemia

Treatment of orthostatic hypotension?

Treatment involves physical measures to reduce venous pooling, increased sodium intake, and sometimes fludrocortisone (mineralocorticoid) or midodrine (peripheral alpha-agonist)