Postural hypotension

Question 1

Define postural hypotension

Answer 1

A fall in systolic blood pressure of at least 20 mmHg (at least 30 mmHg in patients with hypertension) and/or a fall in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing.

Question 2

What are some causes of postural hypotension?

Answer 2

• Medications 
		○ Antihypertensives 
		○ Diuretics 
		○ TCA
	• Hypovolaemia 
	• Prolonged rest
	• Pregnancy 
	• Autonomic neuropathy
		○ Occurs in DM, amyloidosis 
		○ Multi-system atrophy 
	• Neurogenic
		○ Parkinson's
Lewy body dementia

Question 3

What is presentation of postural hypotension?

Answer 3

• Syncope when sitting or standing up which is improved when lying down
  
  • Visual changes
  • Weakness
  • Fatigue
  • May be increased ventilation and dyspnoea

Question 4

Investigations for postural hypotension?

Answer 4

Lying and standing BP

ECG

Tilt table test
24 hour BP monitoring

Question 5

What is management of postural hypotension?

Answer 5

Medication review

treat any underlying cause

lifestyle

falls clinic

Question 6

What are risk factors for postural hypotension

Answer 6

• Increasing age
• Frailty
• Medications which alter sympathetic tone (tamsulosin)
• Dehydration
Comorbidities e.g., diabetes mellitus, Parkinson’s disease, multiple system atrophy

Question 7

What drugs can be trialled to treat postural hypotension

Answer 7

Fludrocortisone

Sympathomimetics e.g. milodrine or ephedrine

Pyridostigmine

Droxidropa (neurogenic)

Question 8

What are complications of postural hypotension

Answer 8

Falls

Supine hypertension