Postural Hypotension

Question 1

What is postural hypotension defined as

Answer 1

A drop in systolic BP >20mmHg or Diastolic >10mmHg after standing up for 3 mins vs lying

Question 2

Who gets it

Answer 2

elderly

Question 3

What causes it

Answer 3

• Hypovolaemia
• Drugs: nitrates, diuretics, antihypertensives, antipsychotics
• Addison’s
• Hypopituitarism (low ACTH)
• Autonomic neuropathy (DM, multisystem atrophy)
• After marathon run (peripheral resistance low for some hours)

Question 4

How do you manage it

Answer 4

• Lie down if faint, stand slowly, water + salt ingestion can help

Physical
- Leg crossing, squatting, elastic compressions + careful exercise

If post-prandial dizziness –> eat little + often - reduce -OH + carb intake

Head-tilt of bed

Fludrocortisone (retains fluid) - beware renal impiarment, low albumin (worsens oedema)