Postural Hypotension

Question 1

Postural Hypotension

When we stand, our bodies should respond to keep our blood pressure the same.

In order for this to happen, 3 things are required:

Answer 1

• normal plasma volume, i.e. the person must not be dehydrated (younger people compensate well for this)
• intact baroreceptors and reflexes
• venomotor tone, the ability of blood vessels to respond to changes in blood flow.

Question 2

Postural Hypotension

What medications can cause it?

Answer 2

• diuretics
• beta-blockers
• other anti-arrhythmics, antihypertensives and vasodilators

Question 3

Postural Hypotension

In general, what happens to our blood vessels as we age which could predispose us to postural hypotension?

Answer 3

Poor vascular compliance : seen in ageing blood vessels due to a reduction in elasticity and increased calcification.

Question 4

Postural Hypotension

Definitions of a ‘significant’ drop in blood pressure:
* Classic
* Initial
* Delayed
* In hypertensive patients

Answer 4

• Classic : reduction of 20/10mmHg within 3 min of standing
• Initial : reduction of 40/20mmHg in first 15 sec – a beat-to-beat recording is required
• Delayed : no agreed definition but occurring >3 min
• In hypertensive patients : reduction of 30mmHg systolic – variability higher in this group

Question 5

Postural Hypotension

How to measure postural hypotension?

Answer 5

1. Ensure that you are able to stand the patient up, getting help beforehand if necessary.
2. Use a manual sphygmomanometer, ideally.
3. Lie the patient down for 5 min.
4. Measure blood pressure.
5. Stand the patient up and measure blood pressure in the first minute.
6. Repeat at 3 min.
7. If blood pressure is still dropping, repeat and keep checking until it resolves.
8. Repeat if symptoms change at any point.

Question 6

Postural Hypotension

Treatment?
(both pharm and non-pharm)

Answer 6

• education / avoidance (getting up slowly / not standing too long / drinking more water)
• preferred medication: Fludrocortisone
• last line medication: Midodrine

Question 7

Postural Hypotension

How does Fludrocortisone work as a treatment?

Answer 7

acts by expanding blood volume and reducing salt loss

Question 8

Postural Hypotension

Question 9

Postural Hypotension

Question 10

Postural Hypotension

Question 11

Postural Hypotension

Question 12

Postural Hypotension

Question 13

Postural Hypotension

Question 14

Postural Hypotension

Question 15

Postural Hypotension