Mechanisms, causes, and evaluation of orthostatic hypotension
- Horacio Kaufmann, MD
Horacio Kaufmann, MD
- Professor of Neurology and Medicine
- New York University School of Medicine
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
When autonomic reflexes are impaired or intravascular volume is markedly depleted, a significant reduction in blood pressure occurs upon standing, a phenomenon termed orthostatic hypotension. Orthostatic hypotension can cause dizziness, syncope, and even angina or stroke.
Symptomatic falls in blood pressure after standing or eating are a frequent clinical problem. The prevalence of orthostatic hypotension varies from 5 to 20 percent in different reports. Many disorders can cause orthostatic hypotension, which can also be a symptom of acute or chronic volume depletion as well as a side effect of drugs, particularly antihypertensives. A related problem, postprandial hypotension (a fall in blood pressure occurring 15 to 90 minutes after meals) is also common in older subjects.
Chronic orthostatic intolerance describes the association of lightheadedness, dizziness, faintness, or syncope that occurs with prolonged standing or upright posture. These symptoms may be sometimes associated with an exaggerated tachycardia but little or no fall in blood pressure, a disorder that is called the postural tachycardia syndrome (POTS).
This topic will review the pathogenesis and causes of orthostatic and postprandial hypotension. The treatment of these syndromes is discussed separately. POTS is also discussed separately (See "Treatment of orthostatic and postprandial hypotension" and "Postural tachycardia syndrome".)
NORMAL BLOOD PRESSURE RESPONSE TO STANDING
Assumption of the upright posture results in the pooling of 500 to 1000 mL of blood in the lower extremities and splanchnic circulation, which initiates the following sequence :
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- NORMAL BLOOD PRESSURE RESPONSE TO STANDING
- EPIDEMIOLOGY AND RISK FACTORS
- Autonomic failure
- - Neurodegenerative disease
- - Neuropathies
- Volume depletion
- RELATED CONDITIONS
- Postprandial hypotension
- Reflex syncope
- Postural tachycardia syndrome and chronic orthostatic intolerance
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS