orthostatic hypotension

Question 1

how is it diagnosed?

Answer 1

diagnosis based largely on typical history of postural symptoms
confirmed by lying/standing blood pressure testing

Question 2

what are the causes?

Answer 2

decreased autonomic buffering capacity - can lead to impaired adaptation of orthostatic stress
triggered by medication
diseases which cause peripheral neuropathy (DM & amyloidosis) can cause autonomic neuropathy and neurogenic orthostatic hypotension
parkinson’s and lewy body dementia

Question 3

how is it managed?

Answer 3

• Stop culprit drugs
• Encourage patient to avoid sudden changes in movements.
• ‘Water loading’
• Increase salt in diet
• Compression stockings
• Keep legs elevated when sitting/sleeping.
• Calf muscle exercises when standing for prolonged periods
• Only when conservative measurements have failed then to consider medication – fludrocortisone, midodrine

Question 4

what are some of the common drugs which trigger orthostatic hypotension?

Answer 4

diuretics, 
anti-hypertensives, 
SNRIs, 
Dopamine agonists, 
pregabalin