Orthostatic hypotension, also known as postural hypotension, is a condition characterized by a significant drop in blood pressure when a person stands up from sitting or lying down. This drop in blood pressure can lead to dizziness, lightheadedness, and even fainting. Orthostatic hypotension can be a symptom of various underlying health issues and can significantly impact a person’s quality of life. There are several types of orthostatic hypotension, each with different causes and implications. Understanding these types can help in diagnosing and managing the condition effectively.
What Are The Types of Orthostatic Hypotension?
1. Primary Orthostatic Hypotension
Primary orthostatic hypotension is often a result of an underlying neurological disorder. It is typically associated with dysfunction in the autonomic nervous system, which controls involuntary bodily functions such as heart rate and blood pressure.
SEE ALSO: What Factors Affect Runners’ Blood Pressure?
Multiple System Atrophy (MSA)
Multiple System Atrophy is a progressive neurodegenerative disorder that affects the autonomic nervous system, leading to symptoms like orthostatic hypotension. In MSA, there is significant degeneration of nerve cells in the brain and spinal cord, which disrupts the regulation of blood pressure upon standing. Patients with MSA often experience severe orthostatic hypotension, making daily activities challenging.
Pure Autonomic Failure (PAF)
Pure Autonomic Failure is a rare neurodegenerative disorder that primarily affects the autonomic nervous system without other neurological symptoms. It leads to a gradual loss of autonomic functions, including blood pressure regulation. PAF is characterized by chronic orthostatic hypotension and other autonomic symptoms like urinary incontinence and erectile dysfunction.
Parkinson’s Disease
Parkinson’s disease is a common neurodegenerative disorder that primarily affects motor functions but can also impact the autonomic nervous system. Many patients with Parkinson’s disease experience orthostatic hypotension due to the degeneration of autonomic neurons. This can lead to significant discomfort and increased risk of falls.
2. Secondary Orthostatic Hypotension
Secondary orthostatic hypotension occurs as a result of another underlying condition or factor. This type is often more manageable because addressing the root cause can alleviate the symptoms.
Medications
Certain medications can cause secondary orthostatic hypotension. These include diuretics, antihypertensives, antidepressants, and medications used to treat Parkinson’s disease. These drugs can affect blood pressure regulation, leading to symptoms of orthostatic hypotension. Adjusting the dosage or changing the medication can often improve the condition.
Dehydration
Dehydration is a common cause of secondary orthostatic hypotension. When the body is dehydrated, blood volume decreases, leading to lower blood pressure. This can be particularly problematic when standing up quickly. Proper hydration and electrolyte balance are crucial in preventing dehydration-induced orthostatic hypotension.
Heart Conditions
Heart conditions such as heart failure, bradycardia, and aortic stenosis can lead to secondary orthostatic hypotension.
These conditions affect the heart’s ability to pump blood effectively, which can result in a significant drop in blood pressure upon standing. Treating the underlying heart condition can help manage orthostatic hypotension.
Endocrine Disorders
Endocrine disorders such as diabetes, adrenal insufficiency, and thyroid dysfunction can also cause secondary orthostatic hypotension.
These disorders can affect the regulation of blood pressure through various mechanisms, including impaired vasoconstriction and reduced blood volume. Managing the endocrine disorder can help alleviate orthostatic hypotension symptoms.
Blood Loss
Acute or chronic blood loss can lead to secondary orthostatic hypotension by reducing the overall blood volume. This can occur due to gastrointestinal bleeding, heavy menstrual periods, or trauma. Addressing the cause of blood loss and replenishing blood volume through fluids or transfusions can help manage orthostatic hypotension.
3. Neurogenic Orthostatic Hypotension
Neurogenic orthostatic hypotension is a specific type of orthostatic hypotension that results from a dysfunction in the autonomic nervous system, often due to neurodegenerative diseases. This type is closely related to primary orthostatic hypotension but is specifically due to autonomic failure.
Dementia with Lewy Bodies
Dementia with Lewy bodies is a type of progressive dementia that affects cognitive and motor functions, as well as the autonomic nervous system. Patients with this condition often experience neurogenic orthostatic hypotension due to the degeneration of autonomic neurons.
Amyloidosis
Amyloidosis is a condition characterized by the abnormal deposition of amyloid proteins in various organs, including the autonomic nervous system. This can lead to neurogenic orthostatic hypotension due to the disruption of normal autonomic functions.
Familial Dysautonomia
Familial dysautonomia, also known as Riley-Day syndrome, is a rare genetic disorder that affects the development and function of the autonomic nervous system. This condition can lead to severe neurogenic orthostatic hypotension, along with other autonomic symptoms such as abnormal sweating, temperature regulation issues, and gastrointestinal problems.
4. Non-neurogenic Orthostatic Hypotension
Non-neurogenic orthostatic hypotension is caused by factors that are not related to the autonomic nervous system. This type is often easier to manage and treat compared to neurogenic orthostatic hypotension.
Postprandial Hypotension
Postprandial hypotension occurs after eating a meal, as blood is diverted to the digestive system, leading to a temporary drop in blood pressure. This type of orthostatic hypotension is common in older adults and individuals with autonomic dysfunction. Managing meal size and composition can help reduce symptoms.
5. Age-Related Orthostatic Hypotension
As people age, the mechanisms that regulate blood pressure can become less efficient, leading to orthostatic hypotension.
This age-related decline in blood pressure regulation is a common cause of dizziness and falls in older adults. Lifestyle modifications and medical management can help mitigate symptoms.
Physical Deconditioning
Prolonged bed rest or physical inactivity can lead to physical deconditioning, resulting in orthostatic hypotension. When the body is not accustomed to standing or moving, the cardiovascular system can struggle to adjust blood pressure appropriately. Gradual physical reconditioning and exercise can help improve symptoms.
Managing Orthostatic Hypotension
Effective management of orthostatic hypotension depends on the underlying cause and type. General management strategies include lifestyle modifications, medication adjustments, and specific treatments for the underlying condition.
Lifestyle Modifications
Hydration: Ensuring adequate hydration can help maintain blood volume and reduce symptoms of orthostatic hypotension.
Diet: Eating smaller, more frequent meals and avoiding large, heavy meals can help prevent postprandial hypotension.
Exercise: Regular physical activity can improve cardiovascular fitness and help regulate blood pressure.
Compression Garments: Wearing compression stockings or abdominal binders can help improve venous return and reduce symptoms.
Medication Adjustments
Reviewing Medications: Adjusting or changing medications that contribute to orthostatic hypotension can help manage symptoms.
Medications for Orthostatic Hypotension: In some cases, medications such as fludrocortisone or midodrine may be prescribed to help increase blood pressure.
Treating Underlying Conditions
Addressing the root cause of secondary orthostatic hypotension, such as managing heart conditions, endocrine disorders, or blood loss, is crucial for effective treatment.
Conclusion
Orthostatic hypotension is a multifaceted condition with various types and underlying causes. Primary orthostatic hypotension is often related to neurodegenerative disorders, while secondary orthostatic hypotension can result from medications, dehydration, heart conditions, endocrine disorders, and blood loss. Neurogenic orthostatic hypotension is specifically linked to autonomic dysfunction due to diseases like dementia with Lewy bodies, amyloidosis, and familial dysautonomia. Non-neurogenic orthostatic hypotension can be caused by factors such as postprandial hypotension, age-related changes, and physical deconditioning. Effective management requires a comprehensive approach, including lifestyle modifications, medication adjustments, and treatment of underlying conditions.