Non-pharmacological management of Orthostatic Hypotension

Orthostatic Hypotension

Definition:

• A systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg  within three minutes of standing.

Causes:

1. Nervous system diseases, such as a neuropathy.
2. Prolonged bed rest.
3. Dehydration.
4. Irregular heart beat(heart arrhythmia).

Symptoms:

1. Dizziness.
2. Weakness.
3. Blurred vision.
4. Fatigue.
5. Fainting.

Treatment options:

   Treatment for hypotension depends on the cause. For example, the dosage of existing medications may need to be altered, or a bleeding stomach ulcers surgically repaired.If no particular cause can be found, drugs may be used to raise blood pressure . In extreme cases, a lower body pressure suit may be required.

Management:

Non-pharmacologic management:

• Slow changes in position.
• Stockings: to increase venous return / decrease lower extremity pooling.
• Temperature: avoid extremes.
• Activities:

                              1.Dorsiflexion several times before standing.
                              2.Before rather than after a meal.
                              3.Afternoon rather than morning.
                              4.Swimming pool.
                              5. Avoid heavy lifting.

• Night time: slight elevation of head of bed.
• Meals normalize salt and water intake.

Pharmacologic management:

Fludrocortisone:

Mechanism: sodium retention.
Midodrine:
Mechanism:  alpha-l-adernoreceptor against increase peripheral vascular resistance.