Postural Hypotension

Question 1

What is it?

Answer 1

A drop in blood pressure upon standing/changing positions

Question 2

Why is it important?

Answer 2

Because it is a common cause of falls and faints in the elderly

Question 3

Why does it happen?

Answer 3

It is due to a number of problems with control of BP

Question 4

What are these control measures?

Answer 4

The baroreflux mechanisms that control heart rate and vascular resistance decline with age

Question 5

What is the definition of postural hypotension?

Answer 5

a drop in BP >20/10mmHg within 3 minutes of standing

Question 6

What conditions precipitate it? (10)

Answer 6

1. Aortic stenosis
2. Arrhythmias
3. MI
4. Dilated cardiomyopathy
5. Heart failure
6. Pernicious anaemia
7. Diabetes
8. Pregnancy
9. Varicose veins
10. Medications e.g Diuretics or excess vasodilator therapy

Question 7

Is it common?

Answer 7

Affects 5% of patients under 50 and 30% of patients over 70

Question 8

Symptoms (12)

Answer 8

*Can be asymptomatic, dizziness, light-headedness, blurred vision, weakness, fatigue, nausea, palpitations, headache, syncope, dyspnoea, chest pain

Question 9

What bloods would you do? (7)

Answer 9

FBC, U&E, fasting glucose, LFT, TFT, BNP, Pregancy tes

Question 10

Other investigations (3)

Answer 10

Lying and standing blood pressure, ECG, ECHO

Question 11

Treatment (5)

Answer 11

Fludrocortisone (mineralocorticoid) that causes sodium retention, avoid sudden temperature changes, stand slowly, compression hoisery, morning dose of caffeine