Postural Hypotension

Question 1

What is postural hypotension?

Answer 1

Postural hypotension is a drop in blood pressure upon standing, defined as a decrease in systolic BP ≥ 20 mmHg or diastolic BP ≥ 10 mmHg within three minutes of standing.

Question 2

Why is postural hypotension significant in older adults?

Answer 2

It is associated with an increased risk of falls, fractures, syncope, and reduced quality of life in older adults.

Question 3

What are the common symptoms of postural hypotension?

Answer 3

Symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, syncope, or falls upon standing.

Question 4

What is the aetiology of postural hypotension?

Answer 4

Causes include age-related physiological changes, medication side effects, autonomic dysfunction, dehydration, and chronic conditions like diabetes or Parkinson’s disease.

Question 5

What are the physiological mechanisms leading to postural hypotension?

Answer 5

It involves inadequate autonomic compensation for the gravitational shift of blood when standing, leading to reduced cerebral perfusion.

Question 6

What are the risk factors for postural hypotension?

Answer 6

Advanced age, polypharmacy, dehydration, autonomic neuropathy, cardiovascular disease, and prolonged bed rest.

Question 7

What medications can cause or worsen postural hypotension?

Answer 7

Antihypertensives (e.g., alpha-blockers, diuretics), antidepressants, antipsychotics, and nitrates.

Question 8

How does dehydration contribute to postural hypotension?

Answer 8

Dehydration reduces intravascular volume, lowering blood pressure and impairing the body’s ability to compensate for positional changes.

Question 9

What is the prevalence of postural hypotension in older adults?

Answer 9

It is common, affecting up to 30% of adults over the age of 65, with prevalence increasing with age and frailty.

Question 10

How is postural hypotension diagnosed?

Answer 10

Diagnosis is made by measuring blood pressure supine and then within three minutes of standing, looking for the characteristic drop in BP.

Question 11

What investigations may be performed to assess postural hypotension?

Answer 11

Blood tests (e.g., to check for anaemia or dehydration), ECG, echocardiography, tilt-table testing, and autonomic function tests.

Question 12

What are the clinical features of postural hypotension?

Answer 12

Symptoms are typically provoked by standing and may include dizziness, lightheadedness, or syncope. Symptoms improve with sitting or lying down.

Question 13

What is the role of a tilt-table test in postural hypotension?

Answer 13

It helps confirm the diagnosis and assess autonomic function by simulating positional changes in a controlled environment.

Question 14

What are some non-pharmacological management strategies for postural hypotension?

Answer 14

Strategies include increased fluid and salt intake, physical counter-manoeuvres, avoiding sudden position changes, and wearing compression stockings.

Question 15

What physical counter-manoeuvres can help reduce symptoms of postural hypotension?

Answer 15

Techniques include leg crossing, squatting, or tensing leg muscles to increase venous return and maintain blood pressure.

Question 16

How can polypharmacy be addressed in patients with postural hypotension?

Answer 16

Reviewing and rationalising medications, discontinuing or adjusting doses of drugs that may exacerbate the condition.

Question 17

What are the pharmacological treatment options for postural hypotension?

Answer 17

Medications such as fludrocortisone or midodrine may be considered for severe or refractory cases.

Question 18

What lifestyle advice should be given to older adults with postural hypotension?

Answer 18

Stay hydrated, rise slowly from sitting or lying positions, avoid large meals or alcohol, and wear compression stockings if advised.

Question 19

How does autonomic dysfunction contribute to postural hypotension?

Answer 19

It impairs the body’s ability to increase vascular tone and heart rate when standing, leading to insufficient blood flow to the brain.

Question 20

What are the complications of untreated postural hypotension?

Answer 20

Increased risk of falls, fractures, syncope, reduced mobility, and a decline in functional independence.

Question 21

How can healthcare providers screen for postural hypotension in older adults?

Answer 21

Regular blood pressure measurements in both supine and standing positions during routine assessments.

Question 22

What is the role of exercise in managing postural hypotension?

Answer 22

Exercise can improve vascular tone and muscle strength, potentially reducing symptoms and improving quality of life.

Question 23

Why is education important for patients with postural hypotension?

Answer 23

Educating patients on recognising symptoms and employing preventive strategies can reduce falls and improve safety.

Question 24

What are the red flags in a patient with postural hypotension?

Answer 24

Symptoms not relieved by positional change, severe or progressive neurological deficits, or associated chest pain or palpitations.

Question 25

Why is multidisciplinary care important in managing postural hypotension in older adults?

Answer 25

It ensures a holistic approach, addressing underlying causes, medication review, lifestyle adjustments, and physical therapy to reduce risk and improve outcomes.