Orthostatic Hypotension – Diagnosis and Treatment
Diagnosis
Providers confirm orthostatic hypotension and determine its cause through careful assessment. They review symptoms, check medical history, and look at current medications.
These steps matter because both the signs of the condition and other health factors guide further tests.
Main steps in diagnosis include:
- Blood Pressure Checks in Different Positions: Providers measure blood pressure while the person lies down, sits, and then stands. A drop in systolic blood pressure by at least 20 mm Hg or diastolic pressure by 10 mm Hg within 2โ5 minutes of standing signals orthostatic hypotension.
- Physical Exam: Providers look for signs of dehydration or symptoms such as dizziness, weakness, or fainting.
- Review of Symptoms and History: Providers ask when symptoms started and how often they occur to help find possible causes.
- Medication Review: Providers check if any drugs the patient takes might lower blood pressure.
Table: Common Tests Used to Evaluate Orthostatic Hypotension
| Test | Purpose | What It Shows |
|---|---|---|
| Blood Pressure Monitoring | Measures BP changes with posture | Confirms orthostatic drop |
| Blood Tests | Checks for anemia or low blood sugar | Finds underlying causes |
| ECG/EKG | Records heartโs electrical activity | Finds rhythm or structural issues |
| Echocardiogram | Uses ultrasound to see the heart | Checks for heart disease |
| Stress Test | Monitors heart during activity or medication | Detects exercise-related changes |
| Valsalva Maneuver | Assesses autonomic nervous system response | Tests heart rate and BP changes |
| Tilt Table Assessment | Evaluates how BP and pulse react to position changes | Mimics move from lying to standing |
Assessing Blood Pressure Changes with Table-Tilting
Providers may recommend a tilt table procedure if regular blood pressure tests do not give clear answers. The person lies flat on a special table, and safety straps keep them secure.
After several minutes, providers gradually raise the table to mimic standing. They closely monitor blood pressure and heart rate throughout the test.
This helps providers see how the heart and nervous system respond to posture changes. They look for symptoms like dizziness or a sudden blood pressure drop when the position changes.
This test helps determine if orthostatic hypotension or another condition causes the symptoms.
Treatment
Prescription Therapies
If lifestyle changes do not control orthostatic hypotension, healthcare providers may recommend medications to help raise blood pressure when standing.
Common classes of medications include:
| Drug Classification | How It Works |
|---|---|
| Alpha-1 agonists | Raises blood pressure by tightening vessels |
| Norepinephrine precursors | Helps the body make more norepinephrine |
| Mineralocorticoids | Raises blood volume |
| Cholinesterase inhibitors | Improves nerve signals to blood vessels |
- Alpha-1 Agonists: These drugs tighten blood vessels to increase blood pressure.
- Norepinephrine Precursors: Help the body produce more norepinephrine, supporting better vascular tone.
- Mineralocorticoids: Increase blood volume by promoting fluid retention.
- Cholinesterase Inhibitors: Improve nerve signaling to the blood vessels, helping maintain stable pressure.
Each medication class has its own benefits and side effects. Treatment is tailored to the individualโs health condition and symptom cause. Doctors usually begin with low doses and adjust as needed.
A medical professional should always supervise the use of these medications.
Treatment
Wearing snug, waist-high support stockings can help by gently squeezing the legs and feet. This pressure helps move blood back toward the heart, which may reduce dizziness or fainting when standing.
Put on support stockings in the morning and wear them during the day. Take them off before bed and when lying down to prevent skin irritation and let the legs rest.
Tip: If putting on stockings is difficult, a stocking donning device can help and reduce strain on the legs and hands.
| Step | Details |
|---|---|
| Put on in the morning | Wear before getting out of bed |
| Remove at night | Take off before sleep or when lying down |
| Use a donning device | Makes applying stockings simpler |
| Check for skin problems | Inspect for redness or irritation daily |
Benefits of Supportive Legwear:
- Helps control blood pooling in the legs
- May lower the chance of dizziness
- Useful for people who stand for long periods
Support stockings can be effective for many people. Use them as part of a management plan discussed with your healthcare provider.
Getting Ready for Your Visit
Steps You Can Take
To make your appointment smoother, wear a short-sleeved or loose long-sleeved shirt so the blood pressure cuff fits easily. This makes it quicker and more comfortable to check your blood pressure.
Keep a record of your blood pressure readings at home. Take your blood pressure first thing in the morning by lying down for the first measurement, waiting a minute, then standing up for the second.
Also, measure your blood pressure:
- After eating
- When symptoms are mild
- When symptoms are stronger
- Right after taking blood pressure medicine
- One hour after taking your medicine
Write down each reading and bring your log to the appointment.
Questions to ask your healthcare provider:
- What might be causing my symptoms?
- Are my medications affecting my blood pressure?
- What other reasons could there be for my symptoms?
- Which tests do I need?
- What is the best treatment choice for me?
- How often should I monitor my blood pressure?
- Can I manage my other health conditions at the same time?
- Are there limits on what I can eat or do?
Prepare a list to bring with you:
| Item | Notes |
|---|---|
| Symptoms | When they started, how often, triggers, severity |
| All medications, vitamins, or supplements | Include doses, or bring the bottles |
| Family history | Any history of low blood pressure or related issues |
| Major stresses or changes | Recent life changes or major events |
| Questions for your provider | List your concerns and things that are unclear |
Bring a family member or friend if possible. They can help you remember what your provider says or help with notes. Do not stop any medications without checking with your provider first.
Diet and Habits
Be ready to discuss your:
- Eating habits
- Daily activity or exercise
- Any challenges with diet or activity
- Amount of salt you consume
What Your Doctor Will Discuss With You
Your provider will ask questions such as:
- How often do your symptoms happen?
- How strong or weak are your symptoms?
- Does anything help your symptoms?
- What makes your symptoms worse?
- Have you ever skipped medications? If so, why?
Your provider will review your symptoms, look for patterns, and check your blood pressure records. They will also consider whether your medications affect your blood pressure.
Examples of provider questions:
| Question | Reason |
|---|---|
| How often do you notice symptoms? | Find patterns |
| What triggers your symptoms? | Learn more about causes |
| What helps or worsens your feelings? | To identify management options |
| Do you sometimes not take your medicine? | To assess medication issues |
You may have your blood pressure checked at the office and possibly at home. Providers may order more tests for additional information.
They may offer tips on lifestyle changes, review your treatment plan, and answer your questions. Open communication helps you manage your health better.
Always be honest about your symptoms, habits, and any medication issues. Sharing clear information helps your provider care for you.
