SCRIPT NUMBER 83
SYMPTOMATIC LOW BLOOD PRESSURE
(ONE SPEAKER)
PROGRAM NAME: HEALTH NUGGETS
PROGRAM TITLE: SYMPTOMATIC LOW BLOOD PRESSURE
PROGRAM NUMBER: 83
SUBJECT: PHYSIOLOGY, SYMPTOMS, CAUSES, TREATMENT OF
ORTHOSTATIC HYPOTENSION
KEY WORDS: ORTHOSTATIC HYPOTENSION, DIABETES, FAINT,
CONSCIOUSNESS, STRENUOUS EXERCISE
DATE OF SCRIPT: OCTOBER 26, 2012
AUTHOR: RICHARD YUKL, MD, FACS
Up to one quarter of normal, older adults experience a feeling of lightheadedness
or dizziness for a short period of time when they stand up from a sitting position,
or if they have been lying in bed. The condition has the medical name of
orthostatic hypotension, a fancy way of describing low blood pressure with
standing up.
When we stand up, gravity causes blood to collect in the blood vessels of our
legs. Because of this, there's less blood returning to our heart to be pumped
around, and our blood pressure drops.
We were created with special cells in the walls of the blood vessels near our
heart and in our neck. These special cells can sense abnormally low blood
pressure, and, once activated, they trigger our heart to beat faster, and our blood
vessels to squeeze, returning our blood pressure to normal. If anything interrupts
this sophisticated control mechanism, low blood pressure will follow.
Common risk factors for interrupting the mechanism and developing orthostatic
hypotension include being older than age 65. As our body ages, those special
cells in our blood vessel walls begin to work slower. Also, as we age, our heart
may become diseased and unable to properly respond when required to do so.
We may have suffered a heart attack, or we may be in heart failure. That may
leave our heart unable beat faster or to work hard enough to pump more blood.
People who take medicines to treat high blood pressure are at a greater risk of
developing low blood pressure when they stand up, especially if they take their
medicines along with other medicines such as nitroglycerine, or if they drink
alcohol, as these chemicals cause their blood vessels to relax too much.
You may experience occasional situations in which your blood volume becomes
too low because of a fever, vomiting, or if you have not been drinking enough
fluids. Untreated diabetes and water pills can cause you to urinate frequently,
also lowering your blood volume and causing you to have low blood pressure
when you stand up.
If you have been required to stay in bed a long time because of an illness, you
may become weak. Then, when you try to stand up, you may experience
symptoms of low blood pressure. Fortunately, once you're feeling better and
regain your muscle strength, these symptoms will likely improve.
The symptoms of orthostatic hypotension are often mild. You may feel faint or
dizzy for a few seconds to a few minutes after standing up. Or, you may develop
weakness, blurry vision or a feeling of confusion for a short time after standing.
Symptoms can, however, also be severe. You could even lose consciousness
and fall. Mild symptoms are only a nuisance, but if they become severe, or if
episodes last longer than a few minutes, they may be the sign of a significant
medical problem, and you should not ignore them. You need to see your doctor if
you frequently feel faint when standing up, and it's even more urgent to see a
doctor if you lose consciousness, even momentarily. You could hurt yourself
when you fall, or you could suffer a stroke because too little blood flows to your
brain during the episodes.
Your doctor will try to identify any serious health problem before dealing with the
low blood pressure itself. This will help determine the correct treatment. Blood
pressure measurements taken as you sit and while you stand will be compared.
Blood tests will determine if you have diabetes as the cause. A heart tracing will
detect any irregular heart rhythm and possibly problems with the blood supply to
your heart muscle.
Treatment will then depend on the identified cause. For mild orthostatic
hypotension, the treatment is simple. If you are sitting or lying down and wish to
stand up, do so slowly, and sit or lie down immediately if you begin to feel
lightheaded. Your symptoms will usually disappear. Lifestyle changes are also
helpful. These changes include drinking adequate amounts of fluid, avoiding the
drinking of alcohol because alcohol relaxes your blood vessels, and avoiding
excessive sweating due to such activities as strenuous exercise during hot
weather. Wearing elastic stockings will help reduce the collection of blood in your
legs and may reduce mild symptoms. Your doctor may also suggest exercise
programs designed to strengthen your leg muscles.
If your symptoms are severe, or if lifestyle changes prove insufficient, your doctor
will prescribe medicines to limit your blood vessels’ ability to relax. That will help
to prevent your blood pressure from falling. If your normal blood pressure is not
high, your doctor may suggest increasing the amount of salt you take in your diet.
If your symptoms are caused by some medicine that you are currently taking,
treatment will usually involve changing the dose of the medicine or stopping it
entirely.
So, what should you do if you have risk factors for developing orthostatic
hypotension, but have no symptoms as yet? The same lifestyle changes we have
already mentioned are important - drink enough fluids, avoid drinking alcohol,
avoid excessive sweating due to such activities as strenuous exercise during hot
weather. Stand up slowly. Sleep with the head of your bed slightly elevated to
help fight the effects of gravity, and sit on the edge of your bed for a minute
before standing up. Additionally, try wearing compression stockings to limit the
amount of blood collecting in your legs, and exercise your calf muscles before
you stand up. If you drop something on the floor, avoid bending at the waist to
recover it. Instead, squat with your knees. All of these changes in your lifestyle
can help your body’s own compensation mechanism work more effectively.
Health Nuggets is written by Dr. Richard Yukl, a medical doctor working in the
United States. The medical views expressed in this program are his and may
differ for your particular health needs. If you need medical advice, please consult
a medical professional in your area.