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

  The 92 droxidopa patients reported 308 falls, and the 105 placebo patients reported 908 falls. [ncbi.nlm.nih.gov]

• Fatigue

  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]

  Cardiology, Neurology Symptoms symptoms that are worse when sitting or standing and improve when lying down, including lightheadedness, vertigo, tinnitus, slurred speech, confusion, coathanger pain in neck and shoulders, grayed or blurred vision, severe fatigue [en.wikipedia.org]

  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]

• 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]

• 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

  Algorithm for the evaluation of orthostatic hypotension. Evaluation of Orthostatic Hypotension FIGURE 1. Algorithm for the evaluation of orthostatic hypotension. [aafp.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]

  BACKGROUND Postprandial hypotension, induced by an absorption of glucose from intestine, could be treated by acarbose; however, it was unclear whether dipeptidyl peptidase-4 inhibitor reduced postprandial hypotension. [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]

• 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: 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]

  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]

• 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

  AIMS: The aim of this study was to assess the involvement of the irregularity of the vertical perception in the dizzy elderly with OH. METHODS: This study consisted of 403 patients seeking treatment for dizziness in our hospital. [ncbi.nlm.nih.gov]

  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

  Orthostatic hypotension Other names Orthostasis, postural, positional hypotension Specialty Cardiology, Neurology Symptoms symptoms that are worse when sitting or standing and improve when lying down, including lightheadedness, vertigo, tinnitus, slurred [en.wikipedia.org]

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

  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]

  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]

• 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]

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.

• Borrelia Burgdorferi

  His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported. [ncbi.nlm.nih.gov]

• 2:1 Atrioventricular Block

  We describe the case of an 81-year-old male patient with long PR interval and episodes of 2:1 atrioventricular block, in whom the implantation of a dual chamber pacemaker led to the disappearance of orthostatic hypotension. [ncbi.nlm.nih.gov]

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.