Orthostatic Hypotension

Author: Kathleen Pace Murphy, PhD, MS, GNP-BC

Key Points

Orthostatic hypotension is estimated to be present in 20 percent of older adults (Fitzgerald, (2010).

Orthostatic hypotension predisposes older adults to an increased risk of falls.

Orthostatic hypotension may be classified as acute or chronic, and symptomatic or asymptomatic.

 

Overview

Orthostatic hypotension is a decrease in systolic blood pressure of greater than or equal to 20 mm of mercury, or a decrease in the diastolic pressure of greater than or equal to 10 mm of mercury when a patient changes from a recumbent or sitting position to a standing position (Lanier, Mote & Clay, 2011).

Normally, when a person assumes an upright position, the autonomic nervous system signals for an increase in lower extremity venous constriction and heart rate to compensate for the postural change. If the patient's autonomic nervous system and/or cardiovascular system do not respond efficiently, the patient may experience a transient decrease in venous return, reduction in cardiac output and a decrease in blood pressure.

Clinical manifestations associated with orthostatic hypotension include dizziness, light-headedness, weakness, headache, fatigue, and in some instances complaints of blurred vision (Fitzgerald, 2010; Lanier et al., 2011).

Causes for orthostatic hypotension include:

 

Assessment

Attain orthostatic blood pressures:

Head up tilt table testing can also be utilized for assessment.

Laboratory test to rule out certain medical conditions may be indicated. Examples include basic metabolic panel, complete blood count, glucose and Vitamin B12. ECG or 24 hour Halter monitoring may be indicated when cardiac arrhythmias are suspected.

 

 

Intervention

Non-pharmacologic and pharmacologic interventions to consider include:

 

References

Fitzgerald, M.A. (2010). Nurse Practitioner. 3rd Edition. Philadelphia: F.A. Davis Company: 308.

Katzung, B. (2007). Special aspects in geriatric pharmacology. In B. Katzung (Ed), Basic and Clinical Pharmacology. 10th Edition. New York, NY: McGraw Medical: 983-990.

Lanier, J.B., Mote, M.B., & Clay, E.C. (2011). Evaluation and management of orthostatic hypotension. American Family Physician; 84(5)527-536.

Stone, L.M. & Stone, P.D. (2007). Syncope. In R.J. Ham, P.D. Sloane, G.A. Warshaw, M.A. Bernard & E. Flaherty (Eds), Primary Care Geriatrics: A Case-Based Approach . 5th Edition. Chapter 20. Philadelphia: Mosby Elsevier.