Orthostatic hypotension
What is orthostatic hypotension?
- Decrease of 20mmHg of systolic BP / 10mmHg of diastolic BP within 3mins when standing compared with the BP during sitting or lying
- Commonly seen in the elderly, individuals with neurologic conditions (eg. Parkinson’s Disease, Diabetic neuropathy)
Ways to prevent orthostatic hypotension: As easy as ABC 😉
A: Abdominal compression
-Wear the abdominal binder when out of the bed
B: Bolus of water
-Drink a glass of water (500ml) rapidly
(It can be used when prolonged standing is expected)
B: Bed up
-Elevate the head of bed 10-20 degrees or 4 inches (about 10cm)
-Maintain upright position during day time
C: Countermaneuvers
- i) Slow marching in place
ii) Toe raising
iii) Leg elevation
iv) Contract muscles below the waist isometrically for the 30s
v) Leg crossing and contract
D: Drugs
- Midodrine
- Fludrocortisone
- Pyridostigmine
E: Exercises
- Mild physical exercises in lying/sitting position
- Recumbent bike, swimming, light weight lifting
F: Fluid and salt
- Fluid intake: Take 8 glasses of water every day
- Salt intake: Take 150-250mmol of sodium (10-20g of salt) per day
- Keep maintaining with high potassium diet (eg. Bananas, and vegetables with high potassium content)
References:
- Figueroa, J. J., Basford, J. R., & Low, P. A. (2010). Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleveland Clinic journal of medicine, 77(5), 298–306. https://doi.org/10.3949/ccjm.77a.09118
- Bouvette CM, McPhee BR, Opfer-Gehrking TL, Low PA. Role of physical countermaneuvers in the management of orthostatic hypotension: efficacy and biofeedback augmentation. Mayo Clin Proc. 1996 Sep;71(9):847-53. doi: 10.4065/71.9.847. PMID: 8790259.
- Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011 Sep 1;84(5):527-36. PMID: 21888303.
Article by
Yue Jia
Physiotherapist