Postural Hypotension Flashcards
What is postural hypotension?
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.
Why is postural hypotension significant in older adults?
It is associated with an increased risk of falls, fractures, syncope, and reduced quality of life in older adults.
What are the common symptoms of postural hypotension?
Symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, syncope, or falls upon standing.
What is the aetiology of postural hypotension?
Causes include age-related physiological changes, medication side effects, autonomic dysfunction, dehydration, and chronic conditions like diabetes or Parkinson’s disease.
What are the physiological mechanisms leading to postural hypotension?
It involves inadequate autonomic compensation for the gravitational shift of blood when standing, leading to reduced cerebral perfusion.
What are the risk factors for postural hypotension?
Advanced age, polypharmacy, dehydration, autonomic neuropathy, cardiovascular disease, and prolonged bed rest.
What medications can cause or worsen postural hypotension?
Antihypertensives (e.g., alpha-blockers, diuretics), antidepressants, antipsychotics, and nitrates.
How does dehydration contribute to postural hypotension?
Dehydration reduces intravascular volume, lowering blood pressure and impairing the body’s ability to compensate for positional changes.
What is the prevalence of postural hypotension in older adults?
It is common, affecting up to 30% of adults over the age of 65, with prevalence increasing with age and frailty.
How is postural hypotension diagnosed?
Diagnosis is made by measuring blood pressure supine and then within three minutes of standing, looking for the characteristic drop in BP.
What investigations may be performed to assess postural hypotension?
Blood tests (e.g., to check for anaemia or dehydration), ECG, echocardiography, tilt-table testing, and autonomic function tests.
What are the clinical features of postural hypotension?
Symptoms are typically provoked by standing and may include dizziness, lightheadedness, or syncope. Symptoms improve with sitting or lying down.
What is the role of a tilt-table test in postural hypotension?
It helps confirm the diagnosis and assess autonomic function by simulating positional changes in a controlled environment.
What are some non-pharmacological management strategies for postural hypotension?
Strategies include increased fluid and salt intake, physical counter-manoeuvres, avoiding sudden position changes, and wearing compression stockings.
What physical counter-manoeuvres can help reduce symptoms of postural hypotension?
Techniques include leg crossing, squatting, or tensing leg muscles to increase venous return and maintain blood pressure.
How can polypharmacy be addressed in patients with postural hypotension?
Reviewing and rationalising medications, discontinuing or adjusting doses of drugs that may exacerbate the condition.
What are the pharmacological treatment options for postural hypotension?
Medications such as fludrocortisone or midodrine may be considered for severe or refractory cases.
What lifestyle advice should be given to older adults with postural hypotension?
Stay hydrated, rise slowly from sitting or lying positions, avoid large meals or alcohol, and wear compression stockings if advised.
How does autonomic dysfunction contribute to postural hypotension?
It impairs the body’s ability to increase vascular tone and heart rate when standing, leading to insufficient blood flow to the brain.
What are the complications of untreated postural hypotension?
Increased risk of falls, fractures, syncope, reduced mobility, and a decline in functional independence.
How can healthcare providers screen for postural hypotension in older adults?
Regular blood pressure measurements in both supine and standing positions during routine assessments.
What is the role of exercise in managing postural hypotension?
Exercise can improve vascular tone and muscle strength, potentially reducing symptoms and improving quality of life.
Why is education important for patients with postural hypotension?
Educating patients on recognising symptoms and employing preventive strategies can reduce falls and improve safety.
What are the red flags in a patient with postural hypotension?
Symptoms not relieved by positional change, severe or progressive neurological deficits, or associated chest pain or palpitations.
