Orthostatic hypotension is defined as an episode of sudden blood pressure (BP) drop, in three or fewer minutes after assuming a standing position, when one was previously lying supine or sitting. In order for the episode to be substantiated as orthostatic hypotension, the BP decrease should amount to 20 mmHg or more in the systolic blood pressure or to 10 mmHg or more in the diastolic blood pressure. In some cases, both the systolic and diastolic blood pressure drop.

Some OH cases are asymptomatic and do remain undiagnosed. Symptomatic OH produces typical symptoms that vary in terms of severity. One of the most commonly reported symptoms is light-headedness and dizziness [1]. A 2014 study reported that 20% of the patients with orthostatic hypotension felt light-headed when standing up. Considerable weakness, nausea, blurred vision and disorientation are also frequently reported symptoms. Fainting is a manifestation of orthostatic hypotension that is significantly severer than the aforementioned ones, although it is less common. The clinical picture is completed by the onset of headaches, shoulder ache or neck pain and chest tightness or dyspnea, on some occasions [2]. The most debilitating effect that OH can exert on a patient is generalized seizures, which have been rarely described. Some individuals experience an aggravation of the symptoms following a heavy meal or physical exercise.

Orthostatic hypotension typically affects senior citizens, even though it is not uncommon amongst the younger population [3] [4] [5].

• Falling

  For IOH upon standing after supine rest, the hemodynamic mechanism can be either a large fall in CO or in SVR. For IOH upon arising from squatting a large fall in SVR is a consistent finding. [ncbi.nlm.nih.gov]

• Fatigue

  It is noteworthy that 91% of INOH patients had complaints of chronic fatigue and that 40 (37%) of 107 children with chronic fatigue were diagnosed as having INOH. [nature.com]

  The patient is a 76 year-old woman who presented with progressive dizziness, anorexia, and fatigue. She had severe orthostatic hypotension (supine systolic blood pressure 186 mmHg and standing 79 mmHg). [ncbi.nlm.nih.gov]

  Is neurally mediated hypotension an unrecognised cause of chronic fatigue ? Lancet 1995 ; 345 : 623 – 624. 5. The importance of orthostatic intolerance in the chronic fatigue syndrome. Am J Med Sci 1999 ; 317 : 117 – 123. 6. [eurheartj.oxfordjournals.org]

• Anemia

  After administration of subcutaneous erythropoietin, his blood pressure drop in the upright position was decreased and symptoms disappeared unassociated with improvement of anemia. [ncbi.nlm.nih.gov]

  Biaggioni et al. found that the serum erythropoietin level was lower in patients with anemia due to autonomic failure than in patients with iron-deficiency anemia (unpublished data). [nejm.org]

  A blood count or measurement of the concentration of red blood cells in the blood (hematocrit) should be done to rule out anemia. [njfaint.com]

• Pallor

  Throughout the procedure, assess her for signs and symptoms of hypotension, including dizziness, light-headedness, pallor, diaphoresis, or syncope (or arrhythmias if she's attached to a cardiac monitor). [journals.lww.com]

  Report all findings to the treating medical provider, including all sets of blood pressure and pulse results, and whether the patient experienced pallor, diaphoresis, or faintness when upright. [ahrq.gov]

  Their symptoms may include most of the symptoms of acute OI, plus: Nausea Neurocognitive deficits, such as attention problems Pallor Sensitivity to heat Sleep problems Other vasomotor symptoms. [1] Causes [ edit ] Symptoms of OI are triggered by the following [en.wikipedia.org]

  When patients showed near-fainting symptoms of dizziness, nausea, sweating, and pallor, the test was immediately stopped and the patients were returned to the supine position. [nature.com]

• Acute Intermittent Porphyria

  "Acute intermittent porphyria associated with postural hypotension". Canadian Medical Association Journal. 121 (7): 845–6. PMC 1704473. PMID 497968. ^ Robertson D, Garland EM (September 2003). "Dopamine Beta-Hydroxylase Deficiency". [en.wikipedia.org]

• Nausea

  Other associated symptoms include neurocognitive or sleep disorders, exercise intolerance, hyperpnea, dyspnea, nausea, abdominal pain, and sweating. [emedicine.medscape.com]

  Considerable weakness, nausea, blurred vision and disorientation are also frequently reported symptoms. Fainting is a manifestation of orthostatic hypotension that is significantly severer than the aforementioned ones, although it is less common. [symptoma.com]

  The most common side effects with NORTHERA are headache, dizziness, nausea, and high blood pressure. Taking NORTHERA with other medications may cause side effects. [northera.com]

  The most common symptoms include headache, nausea, vomiting, blurred vision, and imbalance. The typical appearance on cranial magnetic resonance imaging is hyper-intensity on T2-weighted images and hypo-intensity on T1-weighted images. [go.gale.com]

  Symptoms may include: Blurry vision Dizziness Light-headedness Mental confusion Nausea Muscle tremors Fainting. [betterhealth.vic.gov.au]

• Hypotension

  Overview Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting. [mayoclinic.org]

  […] of orthostatic hypotension. [aafp.org]

  The drop in blood pressure may be sudden (vasovagal orthostatic hypotension), within 3 minutes (classic orthostatic hypotension) or gradual (delayed orthostatic hypotension).[3] It is defined as a fall in systolic blood pressure of at least 20 mm Hg or [en.wikipedia.org]

  Convert to ICD-10-CM : 458.0 converts directly to: 2015/16 ICD-10-CM I95.1 Orthostatic hypotension Approximate Synonyms Hypotension, orthostatic Orthostatic hypotension (low blood pressure upright) Syncope (fainting) due to orthostatic hypotension Syncope [icd9data.com]

• Chronic Hypotension

  INTRODUCTION: Midlife hypertension is associated with dementia in longitudinal studies while chronic hypotension in the elderly is associated with dementia onset. Orthostatic hypotension could influence cognitive performance in the elderly. [ncbi.nlm.nih.gov]

  Chronic hypotension Primary acquired disease of the adrenals: Addison's disease (autoimmune adrenal failure). This is perhaps the best remembered cause of hypotension. [patient.info]

  Chronic hypotension: in the shadow of hypertension. Am J Hypertens. 1992 ; 5 :200S–205S. Crossref Medline Google Scholar 16 Ray Chaudhuri K, Maule S, Thomaides T, Pavitt D, Mathias CJ. [doi.org]

• Sweating

  Fever, vomiting, not drinking enough fluids, severe diarrhea and strenuous exercise with a lot of sweating can all lead to dehydration. Dehydration decreases blood volume. [mayoclinic.org]

  Decreased sweating manifests as heat or exercise intolerance. Patients may have noticeably warm and/or dry skin. The eyes may be affected. [emedicine.medscape.com]

  A detailed medical history is necessary, including symptoms elicited by OH, medications that the patient is taking and autonomic failure indications, such as severe constipation, incontinence, irregular sweating or tingling sensation of the feet. [symptoma.com]

  Certain medications can cause orthostatic hypotension, as can dehydration due to vomiting, diarrhea, untreated diabetes, or excessive sweating. [kidshealth.org]

  Sweating during exercise and water vapor losses through breathing count can result in dehydration if those fluids are not replaced. [njfaint.com]

• Hyperhidrosis

  […] cerebral hypoperfusion Other Factors parkinsonian features cerebellar ataxia weight loss resting tachycardia or impaired heart rate variation abnormal GI motility erectile dysfunction and lack of ejaculation anhidrosis, heat intolerance, dry skin, focal hyperhidrosis [online.epocrates.com]

  […] blackening and tunnel vision); syncope; hearing disturbances (including impaired hearing, crackles and tinnitus); pain in the neck (occipital/paracervical and shoulder region), low back pain or precordial pain; weakness, fatigue, lethargy; palpitations and hyperhidrosis [escardio.org]

• Dizziness

  Orthostatic hypotension signs and symptoms include: Lightheadedness or dizziness upon standing Blurry vision Weakness Fainting (syncope) Confusion When to see a doctor Occasional dizziness or lightheadedness can be minor — triggered by mild dehydration [mayoclinic.org]

  Objective: To compare early vs later OH measurements and their association with history of dizziness and longitudinal adverse outcomes. [ncbi.nlm.nih.gov]

  Dizzy Morning Have you ever felt slightly dizzy when getting up from bed in the morning? There are actually a lot of different names for such an experience, including 'lightheadedness' or 'a head rush'. [study.com]

  Symptoms, which generally occur after sudden standing, include dizziness, lightheadedness, blurred vision, and syncope (temporary loss of consciousness). [ninds.nih.gov]

• Headache

  The patient was admitted to the emergency department of a local hospital within two days due to ongoing headache, elevated temperature, and nuchal rigidity, symptoms suggestive of meningitis. [ncbi.nlm.nih.gov]

  The clinical picture is completed by the onset of headaches, shoulder ache or neck pain and chest tightness or dyspnea, on some occasions. [symptoma.com]

  The most common symptoms include headache, nausea, vomiting, blurred vision, and imbalance. The typical appearance on cranial magnetic resonance imaging is hyper-intensity on T2-weighted images and hypo-intensity on T1-weighted images. [go.gale.com]

• Vertigo

  Twenty-seven of these 55 cases (i.e. 46%) were symptomatic, i.e. associated with at least one of the clinical symptoms of orthostatism (lightheadedness, general weakness, visual disturbance, dizziness, vertigo, malaise, falls, etc.). [pitt.edu]

  The most common symptoms of orthostatic hypotension include weakness, lightheadedness, cognitive impairment, blurred vision, vertigo and tremulousness. [encyclopedia.com]

  Also see Vertigo. [1] M. Eigenbrodt et al [2] 沈漁﹐.精神病學，第3版，北京:人民衛生出版社，1994，11. Sponsors' Ads by Google 以下為谷歌 所提供之廣告 [alternativehealing.org]

  Some also report difficulty concentrating, blurred vision, tremulousness, vertigo, anxiety, palpitations (awareness of the heartbeat), unsteadiness, feeling sweaty or clammy, and sometimes nausea. [en.wikipedia.org]

• Altered Mental Status

  Have severely altered mental status. Have possible spinal injuries. Have lower extremity or pelvic fractures. Are not mobile enough to get out of bed. [ahrq.gov]

  Side effects include sedation, dry mouth, altered mental status, and excessive hypertension. 39 Pyridostigmine, an acetylcholinesterase inhibitor, may be utilized for the treatment of orthostatic hypotension. [uspharmacist.com]

• Giddiness

  Synonym(s): postural hypotension. orthostatic hypotension ; postural hypotension temporary reduction in blood pressure, causing the patient to feel giddy (dizzy) on standing up, or moving from a lying to an erect posture; noted in diabetic patients with [medical-dictionary.thefreedictionary.com]

The diagnosis of orthostatic hypotension is accurate, once blood pressure is measured in a patient who has been in a supine position for minimum 3 minutes, after standing up, as well as 3 and 5 minutes after they stand up. The last measurement is used to detect the extent to which blood pressure may drop upon standing but is not necessary for a decisive diagnosis [7]. Further tests are required in order to unveil the cause of the condition.

A detailed medical history is necessary, including symptoms elicited by OH, medications that the patient is taking and autonomic failure indications, such as severe constipation, incontinence, irregular sweating or tingling sensation of the feet. Physical examination may reveal dry skin and a neurological evaluation should be carried out to look for anything suggestive of Parkinson's disease.

Blood laboratory testing includes a complete blood count, ΗbA1c to diagnose diabetes, serum and urine protein electrophoresis, vitamin B12 and ANA autoantibodies. Plasma catecholamines are also measured, both in a standing and supine position; the measurement needs to take place when the patient is relaxed in a supine position and when they have stood up for at least 5 minutes.

A 24-hour urine sodium level can aid in treatment. [aafp.org]

Paraneoplastic neuropathies associated with leukemia are rare, and early diagnosis and treatment are crucial due to the potential for irreversible neurological deficits and delay in treatment of the leukemia. [ncbi.nlm.nih.gov]

Prognosis The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition. x Prognosis The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition. [ninds.nih.gov]

During the follow-up period, 22 patients (34.4%) had a poor prognosis, of which 8 (36.4%) had OH, which tended to be higher than those with a favorable prognosis. [ncbi.nlm.nih.gov]

Prognosis The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition. [brainfacts.org]

View/Print Table TABLE 2 Clinical Clues to Non-Neurogenic Etiologies of Orthostatic Hypotension Findings on history and physical examination Possible etiology Chest pain, palpations, shortness of breath, rales, edema, arrhythmia, murmur Congestive heart [aafp.org]

FOLLOW UP: If a reversible etiology is identified, orthostatic blood pressure and pulse should be repeated once the etiology is corrected to assure improvement and that multiple etiologies were not contributing factors. [consultgeri.org]

This is the first report showing that midodrine has the potential to improve post-spaceflight orthostatic hypotension and suggesting that reduced venous return contributes to the etiology. [ncbi.nlm.nih.gov]

This review alerts clinicians and clinician scientists to a common, yet often neglected, condition that occurs only upon an active change of posture and discusses its epidemiology, pathophysiology and management. [ncbi.nlm.nih.gov]

This review alerts clinicians and clinician scientists to a common, yet often neglected, condition that occurs only upon an active change of posture and discusses its epidemiology, pathophysiology and management. blood pressure dizziness initial orthostatic [doi.org]

Monoamine oxidase inhibitors may cause OH by depleting norepinephrine.12 Epidemiology OH is common in elderly patients and increases with age. [ajmc.com]

The pathophysiology of IOH is thought to be a temporal mismatch between cardiac output and vascular resistance. [ncbi.nlm.nih.gov]

To stabilize hemodynamics and prevent presyncope symptoms in these patients, noninvasive management is preferable. [ncbi.nlm.nih.gov]

Primary prevention of orthostatic hypotension is key. To prevent orthostatic hypotension, the modifiable risk factors must be considered. [healio.com]

The drug pyridostigmine is often quite helpful in preventing supine OH without worsening SH. In some SH/OH patients the swings in blood pressure are so extreme that midodrine or droxidopa is administered when upright to prevent OH. [innovationsincrm.com]

1. Alagiakrishnan K, Patel K, Desai RV, et al. Orthostatic Hypotension and Incident Heart Failure in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci. 2014 Feb; 69A(2): 223–230.
2. Robertson D, Kincaid DW, Haile V, Robertson RM. The head and neck discomfort of autonomic failure: An unrecognized aetiology of headache. Clin Auton Res. 1994 Jun;4(3):99–103. [PubMed]
3. Kawaguchi T, Uyama O, Konishi M, Nishiyama T, Iida T. Orthostatic hypotension in elderly persons during passive standing: a comparison with young persons. J Gerontol A Biol Sci Med Sci. 2001;56:M273–M280
4. Belmin J, Abderrhamane M, Medjahed S, et al. Variability of blood pressure response to orthostatism and reproducibility of the diagnosis of orthostatic hypotension in elderly subjects. J Gerontol A Biol Sci Med Sci. 2000;55:M667–M671.
5. Ooi WL, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med. 2000;108:106–111
6. Gehrking JA, Hines SM, Benrud-Larson LM, Opher-Gehrking TL, Low PA. What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension? Clin Auton Res. 2005 Apr;15(2):71–5.
7. Goldstein DS. Dysautonomia in parkinson disease. Compr Physiol. 2014 Apr;4(2):805–26.