orthostatic_hypotension
Orthostatic Hypotension
Definition
- an abnormal drop in BP on standing from lying and further defined as:
- a fall in sBP of at least 20mmHg, or below 90mmHg, with or without symptom
- a fall in dBP of 10mmHg with symptoms
Patient needs to be lying for 5mins, then BP measured after standing for 1min and then again at 3mins
Causes
- Neurological:
- neurodegenerative diseases eg Parkinsons and Parkinson-plus syndromes, some dementia
- pure autonomic failure (PAF) – Bradbury-Eggleston syndrome
- secondary to diabetes, vitB deficiency, renal failure, amyloidosis, HIV other autoimmune
- Other:
- volume depletion – dehydration, anaemia
- alcohol and drugs/medications
- cardiovascular disease, adrenal insufficiency, sepsis
- ageing, idiopathic
Investigation
- baseline Ix – electrolytes, FBC, ECG, Glu
- other - appropriate to likely/possible underlying cause
- may need Tilt Testing to confirm
Management
- treatment of primary cause if known and relevant
- non pharmacological measures to consider first:
- rehydration when appropriate
- may need to add salt to diet – caution in Heart Failure or Renal Failure
- compression stockings
- education regarding exercise, diet, care with changes in postion
- review medications
- Pharmacological (either or in combination):
- Fludrocortisone – 100mcg (>65yo 50mcg) nocte initially
- Midodrine – 2.5mg tds up to 10mg tds