2024-11-07 08:09:00
Orthostatic hypotension – a drop in blood pressure when standing up – must be addressed because it increases the risk of falls and cardiovascular disease. We take stock.
What is orthostatic hypotension?
Orthostatic hypotension results in a drop in blood pressure when standing compared to lying down, explains Dr Quentin Estrade, cardiologist at Rangueil University Hospital in Toulouse.
This phenomenon occurs more readily in elderly people. “It concerns 7% of the population and up to 16% after the age of 65,” he emphasizes.
When we get up, a drop in blood pressure occurs, normally compensated very quickly (within the first 15 seconds) by a cardiovascular reflex. An acceleration of the heart rate makes it possible to adjust the blood pressure to its usual level, which ideally does not exceed 130/80 mmHg.
In the cases oforthostatic hypotension, the autonomic nervous system which manages this adaptation is disrupted and the first, highest number (systolic pressure) suddenly decreases by at least 20 mmHg and/or the second number (diastolic) by at least 10 mmHg, within 3 minutes after getting up. The brain is then no longer sufficiently irrigated.
What causes orthostatic hypotension?
Of the maladies can be at the origin: “Parkinson’s disease, diabetes, renal or venous insufficiency, certain cancers, alter this natural ability to regulate pressure when getting up”, observes the cardiologist; But also medicines : certain antihypertensives, antidepressants and neuroleptics; Can also disrupt this mechanism: dehydrationand too strict salt-free diet, a vitamin B deficiencya undernutritiona anemiaor a prolonged bed rest.
However, you should know that sometimes no cause is identified.
How is orthostatic hypotension diagnosed?
Orthostatic hypotension is manifested by:
Dizziness; The feeling of spinning; Fatigue, confusion; Headaches, Visual disturbances, even loss of consciousness… or nothing at all.
To highlight it : Blood pressure should be measured 1 and 3 minutes after moving from lying to standing. It can happen that orthostatic hypotension occurs later, at 9-10 minutes, and it is in this case that the blood pressure holter is valuable. It is indeed the most effective tool, to be worn for at least one day. To more reliably diagnose orthostatic hypotension, one must be lying down rather than sitting before standing up (the result is otherwise less sensitive).
Orthostatic hypotension: is it serious?
Yes rather, because orthostatic hypotension increases the risk of falling (+ 73%), but alsomyocardial infarction (+ 30 %), d’stroke (+64%), from hypoperfusion dementia (+ 37%) and mortality (+ 36 %).
How to treat orthostatic hypotension?
There is no real treatment orthostatic hypotension, apart from adjustment of antihypertensive treatment if necessary (see box). “The simplest, non-pharmacological measures are effective and safe,” reassures Dr. Estrade. They aim to facilitate the brain’s work of adaptation.
Here are the simplest ones to adopt:
Get up slowly is the base, breaking down the movement;Drink 2 liters per day and limit your alcohol consumption;Raise the head of the bed by 10° ;Adopt class 2 compression socks or stockings during the day to increase venous return and, in turn, brain irrigation;Trampling when standing still for a long time to activate the muscle pump in the sole of the foot and calf.
To reduce the risk ofhypotension orthostatique postprandialemore common after a meal rich in carbohydrates, when blood rushes and stagnates in the digestive tract, some tips:
Break up meals, making them lighter; Drink a large glass of water before and during the meal; Take your antihypertensive medication at a distance and, for those who can, plan a short nap.
Orthostatic hypotension: what to do if you feel unwell?
We immediately adopt these emergency maneuvers:
Hook both hands firmly in front of the sternum Then spread them vigorously or squeeze a small ball tightly in his hand:Trample ;Drink a large glass of water.
When hypertension and orthostatic hypotension coexist
It is often necessary to readjust, with your doctor (never alone!), your antihypertensive treatment. Certain medications (beta blockers) are obviously at greater risk of orthostatic hypotension: it is better to keep calcium channel blockers and ACE inhibitors, possibly by slightly reducing the doses. With the authorization and under the supervision of your doctor, you can also reintroduce a little salt into your diet.
Sources
Interview with Dr Quentin Estrade, cardiologist at Rangueil University Hospital in Toulouse.
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**Interview with Dr. Quentin Estrade on Orthostatic Hypotension**
*Date: November 7, 2024*
**Interviewer:** Good morning, Dr. Estrade. Thank you for joining us today to discuss orthostatic hypotension. To start, can you explain what orthostatic hypotension is and why it’s particularly concerning for older adults?
**Dr. Estrade:** Good morning, and thank you for having me. Orthostatic hypotension occurs when a person experiences a significant drop in blood pressure upon standing up, compared to when they’re lying down. It’s especially prevalent in the elderly, affecting about 7% of the general population and up to 16% of those over 65. This condition can lead to dizziness, fainting, and an increased risk of falls, which can be particularly dangerous for older individuals.
**Interviewer:** What causes this drop in blood pressure?
**Dr. Estrade:** Several factors can contribute to orthostatic hypotension. It can be caused by various medical conditions like Parkinson’s disease or diabetes, as well as certain medications such as antihypertensives and antidepressants. Lifestyle factors, including dehydration and inadequate dietary salt, can also play a role. Notably, sometimes no identifiable cause is found.
**Interviewer:** How can one identify if they have orthostatic hypotension?
**Dr. Estrade:** Diagnosis typically involves checking blood pressure while lying down and then again 1 to 3 minutes after standing up. Symptoms can include dizziness, fatigue, and visual disturbances. In some cases, a Holter monitor may be used if the hypotension appears later after standing.
**Interviewer:** What are the seriousness and possible risks associated with this condition?
**Dr. Estrade:** Orthostatic hypotension is indeed serious. It significantly increases the risk of falls, myocardial infarction, and even stroke. The statistics are alarming, with risks rising by over 70% for falls and around 30% for heart attacks.
**Interviewer:** Are there effective treatments or management strategies for managing orthostatic hypotension?
**Dr. Estrade:** While there is no definitive treatment for orthostatic hypotension, adjusting any contributing medications is essential. Non-pharmacological strategies can be quite effective. For instance, I recommend that patients get up slowly, increase their fluid intake, and elevate the head of their bed to facilitate better blood circulation.
**Interviewer:** Those sound like very practical steps. Is there anything else you’d like to emphasize about managing this condition?
**Dr. Estrade:** Yes, it’s crucial to recognize the symptoms and seek advice, especially for older adults. Implementing these lifestyle changes can significantly improve quality of life and reduce risks. Education about the condition is key to preventing harmful falls and other serious health implications.
**Interviewer:** Thank you, Dr. Estrade, for sharing your insights on orthostatic hypotension. It’s important for people to be aware of this condition and take proactive steps to manage it.
**Dr. Estrade:** Thank you for having me. It’s a pleasure to raise awareness about this important health issue.
