How does one assess for postural hypotension?

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Postural hypotension is also known as orthostatic hypotension. Postural hypotension is a condition where blood pressure radically decreases under 20mmHg after an individual changes the position of their body, for example, from lying down to standing up. Postural hypotension is a common medical condition that is primarily found in older individuals. However, younger individuals can suffer from postural hypotension also. The condition is caused by a disruption in the normal function of the autonomic nervous system. The job of the autonomic nervous system is to regulate blood pressure. Postural hypotension occurs when gravity induces blood to pool in the lower extremities, creating a compromised venous return, the final result being a decrease in cardiac output and consequent arterial pressure decrease. Due to insufficient blood in the upper extremities, when an individual goes from a position of lying down to a position of standing up, a decrease of systolic and diastolic blood pressure occurs. Symptoms of postural hypotension can include bodily dissociation, dizziness, distortions in hearing, euphoria, nausea, lightheadedness, headache, fainting, tingling in the extremities, dimmed vision, upper back and shoulder pain, and possible vasovagal syncope.

In order to assess for postural hypotension, medical practitioners need to look at the underlying causes that could have precipitated this medical condition. Dehydration is a systemic cause of postural hypotension. When an individual becomes dehydrated, due to vomiting, fever, not enough fluid intake, strenuous exercise, and/or severe diarrhea, this creates a decrease of water in the body, as well as decreased sodium intake. This causes fatigue, dizziness, and weakness that can cause postural hypotension. Another systemic cause is when an individual is sitting or lying down for an extended period of time. This is prevalent in individuals who have mobility issues or have been on bed rest for a prolonged period of time. One last systemic cause is adrenal insufficiency, a condition where the adrenal glands are not able to create sufficient quantities of the steroid hormones that control potassium, sodium, and the retention of water. A symptom of adrenal insufficiency is postural hypotension.

Diseases associated with postural hypotension include Addison’s disease, atherosclerosis, pheochromocytoma, multiple system atrophy, and other varieties of dysautonomia – medical conditions that affect the autonomic nervous system where postural hypotension is one of the primary symptoms. Postural hypotension is also found in many individuals who suffer from Parkinson’s disease, either as a side effect of dopaminomimetic therapy or because of sympathetic denervation of the heart. Postural hypotension is also prevalent in individuals who are paraplegics and quadriplegics, due to the inability of multiple systems in the body to keep up normal blood pressure and blood flow to the upper half of the body. Diabetes is another related disease that can cause postural hypotension due to the dehydration and nerve damage that affects the signals being sent in relation to blood pressure. Recently, the Harvard Medical School assessed that postural hypotension was associated with inner ear problems due to the likelihood of a shortage of blood flow to the brain.

Certain medications can also cause postural hypotension. This list of medications includes antipsychotics, antidepressants, antihypertensives, vasodilators, diuretics, beta-blockers, and medications that inhibit angiotension.

Other factors that are used to assess if postural hypotension is present include: if the patient is a postpartum mother; teenagers that have grown a lot in a minimal time period; individuals suffering from bulimia nervosa and anorexia nervosa; as well as recreational drug use and chronic alcohol consumption.

To do a proper assessment, a medical professional is directed to take many measurements of blood pressure during different points of the day and a complete medical history should be completed to spot for medications and conditions. Lastly, it is important to do a proper physical examination, paying specific focus to autonomic diseases and symptoms.

Resource by A.Moore

I just moved to Michigan from South Carolina. This is my first winter here and so far it's freezing. I enjoy traveling, drawing, camping, writing, and doing community service in my spare time. I work for a education company and help them with their outreach to teachers and students. Hope everyone enjoys my articles.

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