Orthostatic Hypotension and Dizziness – How to Cope

Introduction

Orthostatic hypotension (OH) is a medical condition that occurs when a person’s blood pressure suddenly drops after they stand up from a sitting or lying down position. This sudden decrease in blood pressure can cause several uncomfortable symptoms, including dizziness, feeling lightheaded, and in some cases, even fainting. It’s important to understand OH because it can greatly affect a person’s daily life and increase their risk of falling or experiencing other health problems.

When someone has OH, their body doesn’t adjust to the change in position quickly enough. Normally, when we stand up, our blood vessels tighten and our heart rate increases to keep blood flowing to our brain. But in people with OH, this process doesn’t work as well, leading to a temporary lack of blood flow to the brain.

OH can happen to anyone, but it’s more common in older adults and people with certain health conditions. Some causes of OH include:

• Dehydration, which means not having enough water in your body
• Some medications, especially those used to treat high blood pressure
• Health problems that affect the nervous system, like Parkinson’s disease or diabetes
• Heart problems that make it hard for the heart to pump blood effectively

The symptoms of OH can be scary and make it hard to do everyday activities. People with OH might feel dizzy or lightheaded when they stand up, and they might also experience blurry vision, weakness, or confusion. In severe cases, they might even faint or fall.

Doctors can diagnose OH by measuring a person’s blood pressure when they’re lying down and then again when they stand up. If there’s a big drop in blood pressure upon standing, it could mean the person has OH.

OH can affect many parts of a person’s life. It might make them afraid to stand up quickly or do certain activities. This fear can lead to less physical activity, which isn’t good for overall health. OH can also make it harder to do simple tasks like getting out of bed or standing up from a chair.

There are several health conditions that often go along with OH. These include:

• High blood pressure when lying down
• Heart problems
• Nervous system disorders
• Diabetes
• Anemia, which is when a person doesn’t have enough healthy red blood cells

Understanding OH is the first step in learning how to manage it. By knowing what causes OH, how it affects the body, and what symptoms to look out for, people can work with their doctors to find the best ways to cope with this condition and improve their quality of life.

Understanding Orthostatic Hypotension

Definition and Causes of OH

Orthostatic hypotension, often called OH for short, is a medical condition where a person’s blood pressure drops suddenly when they stand up. Doctors define it as a decrease in blood pressure of at least 20 mmHg in systolic pressure or 10 mmHg in diastolic pressure. This drop happens within three minutes of standing up after lying down for five minutes or being at a 60-degree angle on a special table called a tilt table.

Many things can cause OH. One common cause is not drinking enough water, which leads to dehydration. When people stay in bed for a long time, like when they’re sick, they can also develop OH. Some medicines can cause OH as a side effect. Health problems like diabetes, high blood pressure, and diseases that affect the nerves can also lead to OH.

Symptoms and Diagnosis

When someone has OH, they might feel dizzy or lightheaded when they stand up. Their vision might get blurry, and they might feel weak. Sometimes, people with OH can even faint, which doctors call syncope. They might also feel confused. These feelings usually don’t last long, but they can be strong enough to make a person fall down.

To figure out if someone has OH, doctors measure their blood pressure when they’re lying down and then again when they stand up. They might also do other tests to find out what’s causing the OH. These tests can include blood tests, heart tests, or tests that look at how the nerves are working.

How OH Affects Daily Life

OH can make everyday activities hard to do. Simple things like getting out of bed or taking a shower can become challenging. People with OH are more likely to fall, which can be very dangerous, especially for older adults. Falls can cause broken bones or other serious injuries.

OH can also affect how people feel emotionally. They might start to feel anxious or scared about falling. Some people might feel sad or depressed because they can’t do the things they used to do easily. This can make them less likely to go out or spend time with friends and family.

Common Conditions Associated with OH

OH often happens along with other health problems. Diabetes is one of these problems. In diabetes, the nerves that control blood pressure can get damaged, which can lead to OH. High blood pressure, also called hypertension, can also be linked to OH. Sometimes, the medicines used to treat high blood pressure can cause OH if they’re not used correctly.

Some diseases that affect the brain and nerves can also cause OH. Parkinson’s disease is one example. Another is a condition called multiple system atrophy. These diseases can affect the part of the nervous system that controls things like heart rate and blood pressure automatically. When this system doesn’t work right, it can lead to OH.

Causes of Dizziness in Orthostatic Hypotension

Physiological Changes Leading to Dizziness

When a person stands up, their body needs to quickly adjust to the new position to keep blood flowing to the brain. In orthostatic hypotension (OH), the body’s automatic system for controlling blood pressure doesn’t work properly. This system, called the autonomic nervous system, fails to respond correctly when a person stands up. As a result, blood pressure drops suddenly. This drop in blood pressure means less blood flows to the brain, which causes feelings of dizziness and lightheadedness. The brain needs a steady supply of blood to work well, so when it doesn’t get enough, a person can feel dizzy or even faint.

Role of Blood Pressure and Circulation

Blood pressure is very important for keeping our bodies working properly. It’s the force that pushes blood against the walls of our arteries as the heart pumps. In OH, when a person stands up, their blood pressure drops too much, too quickly. This sudden drop means there isn’t enough force to push blood up to the brain. Good circulation is crucial for maintaining the right blood pressure. When circulation is poor, it’s harder for the body to adjust blood pressure quickly, which can lead to dizziness. The heart, blood vessels, and nervous system all work together to keep blood flowing properly, but in OH, this system doesn’t work as well as it should.

Impact of Dehydration and Electrolyte Imbalance

Not having enough water in the body (dehydration) and having an imbalance of important minerals (electrolytes) can make OH symptoms worse. When a person is dehydrated, there’s less blood in their body. This makes it harder for the heart to pump blood effectively, especially when standing up. Electrolytes like sodium and potassium are very important for keeping blood pressure steady and helping nerves work properly. If these electrolytes are out of balance, the body might not be able to control blood pressure well. This can lead to more dizziness when standing up. Drinking enough water and eating a balanced diet can help keep electrolytes in balance and reduce the risk of dizziness from OH.

Other Contributing Factors

There are several other things that can make OH-related dizziness worse:

1. Medications: Some medicines, especially those used to lower blood pressure or affect the nervous system, can make OH symptoms more severe. For example, diuretics (water pills) or certain antidepressants might increase the risk of dizziness when standing up.

2. Age: As people get older, their bodies become less able to adjust quickly to changes in position. The systems that control blood pressure naturally slow down with age, making older adults more likely to experience OH.

3. Underlying health conditions: Some illnesses can contribute to OH. Anemia, a condition where there aren’t enough healthy red blood cells to carry oxygen around the body, can make dizziness worse. Heart problems, like heart failure, can affect how well the heart pumps blood. Thyroid disorders can also impact blood pressure regulation and increase the risk of OH.

4. Prolonged bed rest: When people stay in bed for a long time due to illness or injury, their bodies can become less efficient at adjusting to position changes, making OH more likely when they start moving around again.

5. Hot environments: Being in a hot place can cause blood vessels to expand, which can lead to a drop in blood pressure and increase the risk of dizziness when standing up.

Understanding these factors can help people with OH and their healthcare providers manage the condition more effectively and reduce episodes of dizziness.

Coping Strategies for OH-Related Dizziness

Lifestyle Changes

Diet and Hydration

Managing orthostatic hypotension (OH) through diet and hydration is crucial. Drinking plenty of water throughout the day helps maintain blood volume, which is essential for proper circulation. Aim for at least 8 glasses of water daily, and increase intake during hot weather or physical activity. Consuming electrolyte-rich foods like bananas, oranges, and leafy greens can help balance electrolytes in the body. It’s important to limit or avoid alcohol and caffeine, as these substances can lead to dehydration and worsen OH symptoms. Instead, opt for herbal teas or water-rich fruits like watermelon to stay hydrated.

Exercise and Physical Activity

Regular exercise is beneficial for managing OH, but it’s important to choose the right types of activities. Gentle exercises like yoga, tai chi, and walking can improve circulation without putting too much strain on the body. Start with short sessions and gradually increase duration as tolerated. Swimming is another excellent option, as the water pressure can help improve blood flow. Avoid standing for long periods, and take frequent breaks to sit or lie down during activities. When exercising, be sure to stay hydrated and avoid overheating, as this can worsen OH symptoms.

Sleep and Stress Management

Getting enough quality sleep is crucial for managing OH. Aim for 7-9 hours of sleep per night in a cool, dark room. Establish a regular sleep schedule and avoid electronic devices before bedtime. Stress can worsen OH symptoms by increasing blood pressure variability, so it’s important to incorporate stress-management techniques into daily life. Practice deep breathing exercises, progressive muscle relaxation, or guided imagery to reduce stress. Consider taking up a hobby or engaging in activities you enjoy to help manage stress levels throughout the day.

Medical Interventions

Medications for OH

Several medications can help manage OH symptoms. Fludrocortisone helps increase blood volume by retaining salt and water. Midodrine works by constricting blood vessels, which can raise blood pressure. Pyridostigmine improves nerve signals to blood vessels, helping them maintain proper tone. It’s crucial to work closely with a healthcare provider when using these medications, as they can have side effects and may interact with other drugs. Regular check-ups and blood pressure monitoring are necessary to ensure the medications are working effectively and safely.

Compression Stockings and Other Devices

Compression stockings are a non-invasive way to manage OH. These tight-fitting socks apply pressure to the legs, helping to push blood back up towards the heart and reduce blood pooling in the lower extremities. They come in different compression levels, so it’s important to consult with a healthcare provider to find the right fit. Abdominal binders are another useful device that can help increase blood pressure by applying pressure to the abdomen. Some people may benefit from using a cane or walker to provide support and reduce the risk of falls when experiencing dizziness.

Alternative Therapies

Acupuncture and Herbal Remedies

Acupuncture, an ancient Chinese healing practice, may help improve circulation and reduce OH symptoms. It involves inserting thin needles into specific points on the body to promote healing and balance. Some herbal remedies, such as ginseng and licorice root, have been reported to help with OH symptoms. Ginseng may improve circulation, while licorice root can help increase blood pressure. However, it’s crucial to consult with a healthcare provider before trying any herbal remedies, as they can interact with medications and may not be suitable for everyone.

Yoga and Meditation

Yoga and meditation can be effective in managing OH symptoms. Gentle yoga poses, especially those performed while seated or lying down, can help improve circulation without causing a sudden drop in blood pressure. Meditation techniques, such as mindfulness and focused breathing, can help reduce stress and promote relaxation. These practices can also improve overall body awareness, which may help individuals recognize and respond to early signs of dizziness or lightheadedness. Start with short sessions and gradually increase duration as you become more comfortable with the practices.

Managing OH in Daily Life

Tips for Daily Activities

Getting Up from Bed

When dealing with orthostatic hypotension (OH), getting out of bed can be a challenging task. It’s crucial to take your time and move slowly to prevent dizziness. Start by sitting up in bed for a few minutes before attempting to stand. This allows your body to adjust gradually to the change in position. If you feel unsteady, use a bedside table or chair for support. You can also try doing some gentle exercises while still in bed, such as ankle pumps or leg stretches, to help improve blood flow before standing up.

Taking a Shower

Showering can be risky for people with OH due to the potential for falls. To make showering safer, consider using a shower chair or a sturdy bath bench. This allows you to sit down while bathing, reducing the risk of dizziness and falls. Install non-slip mats both inside and outside the shower to provide better traction. It’s also helpful to use a handheld showerhead, which allows you to wash while seated. Avoid using very hot water, as it can worsen OH symptoms. Take breaks during your shower if you start feeling lightheaded, and don’t rush through the process.

Strategies for Avoiding Triggers

Dehydration

Staying well-hydrated is essential for managing OH. Drink plenty of water throughout the day, aiming for at least 8 glasses. You can also consume electrolyte-rich beverages or add electrolyte powder to your water. Eating foods high in water content, such as fruits and vegetables, can help maintain hydration. Limit your intake of alcohol and caffeine, as these can lead to dehydration and worsen OH symptoms. If you struggle to drink enough water, try setting reminders on your phone or using a water tracking app.

Overheating

Heat can worsen OH symptoms, so it’s important to stay cool. Wear lightweight, breathable clothing in warm weather. Use fans or air conditioning to keep your environment cool. When outdoors, seek shade and avoid prolonged exposure to direct sunlight. Consider using cooling products like neck wraps or misting fans. If you start feeling overheated, take a break in a cool area and drink some water. Planning outdoor activities for cooler parts of the day, such as early morning or evening, can also help.

Importance of Self-Monitoring and Tracking Symptoms

Keeping track of your OH symptoms is crucial for effective management. Use a journal or smartphone app to record when symptoms occur, how long they last, and what you were doing at the time. Note any potential triggers, such as certain foods, activities, or medications. Also, track your blood pressure readings at different times of the day. This information can help you and your healthcare provider identify patterns and adjust your treatment plan as needed. Regular monitoring can also help you recognize early warning signs of an OH episode, allowing you to take preventive actions.

Building a Support Network

Having a strong support system is vital when living with OH. Share information about your condition with family members and close friends so they can understand your challenges and offer appropriate help. Consider joining a support group for people with OH or related conditions. These groups can provide valuable tips and emotional support. Work closely with your healthcare team, including your primary care doctor, neurologist, and any specialists involved in your care. Don’t hesitate to reach out to them with questions or concerns. Having a reliable network can reduce stress and improve your overall quality of life while managing OH.

Conclusion

Orthostatic hypotension is a challenging condition that can have a significant impact on a person’s daily life. It often causes dizziness and lightheadedness when standing up, and in some cases, can even lead to fainting. These symptoms can make simple tasks like getting out of bed or standing up from a chair feel difficult and scary.

Understanding what causes orthostatic hypotension and recognizing its symptoms is very important for managing the condition effectively. Some common causes include dehydration, certain medications, and underlying health problems. By learning about these causes, people can work with their doctors to find the best ways to address them.

There are many ways to manage orthostatic hypotension and reduce its effects on daily life. Making changes to your lifestyle can be a big help. This might include drinking more water, eating smaller meals more often, and avoiding sudden movements when standing up. Some people find that wearing compression stockings or sleeping with the head of their bed slightly raised can also make a difference.

In some cases, doctors may recommend medications to help control blood pressure and reduce symptoms. These medicines can be very helpful, but it’s important to take them exactly as prescribed and to let your doctor know about any side effects.

Alternative therapies, like acupuncture or certain exercises, might also provide relief for some people. While these methods may not work for everyone, they can be worth trying under the guidance of a healthcare professional.

One of the most important things for people with orthostatic hypotension is to reduce the risk of falls. This might mean making changes to the home environment, like adding grab bars in the bathroom or removing tripping hazards. It’s also a good idea to move slowly and carefully when changing positions.

Managing orthostatic hypotension is not a one-size-fits-all process. What works for one person might not work for another. That’s why it’s so important to work closely with healthcare providers to create a plan that’s just right for each individual. This plan might change over time as symptoms or circumstances change.

Having a strong support network can make a big difference when dealing with orthostatic hypotension. Family members, friends, and caregivers can help with daily tasks, provide emotional support, and even assist in emergencies. Support groups, either in-person or online, can also be a great resource for sharing experiences and tips with others who understand the challenges of living with this condition.

By taking a comprehensive approach to managing orthostatic hypotension, many people are able to improve their symptoms and enjoy a better quality of life. While it may take some time and effort to find the right combination of strategies, the result can be a safer, more comfortable, and more independent daily life.

References

1. Mayo Clinic. Orthostatic hypotension (postural hypotension) – Symptoms & causes. https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548. Accessed March 5, 2022.

2. StatPearls. Orthostatic Hypotension. https://www.ncbi.nlm.nih.gov/books/NBK448192/. Accessed March 5, 2022.

3. NORD. Orthostatic Hypotension. https://rarediseases.org/rare-diseases/orthostatic-hypotension/. Accessed March 5, 2022.

4. Cleveland Clinic. Orthostatic Hypotension. https://my.clevelandclinic.org/health/diseases/9385-low-blood-pressure-orthostatic-hypotension. Accessed March 5, 2022.

5. Better Health Channel. Dizziness – orthostatic hypotension. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dizziness-orthostatic-hypotension. Accessed March 5, 2022.