Orthostatic hypotension (OH) also known as postural hypotension is defined as a sudden drop in blood pressure upon standing from a sitting or laying down position.

Diagnosis is confirmed if the blood pressure reduces to about 20mmHg systolically and 10mmHg diastolically or more. This drop in BP occurs within 3 minutes of standing up after being in supine position for 5 minutes or 60% angle on a tilt table. This rapid drop in BP can be caused by the failure of autonomic reflex, volume depletion, or undesirable reaction to medicines. Frequent falls occur due to this disease, ensuing high rate of morbidity and mortality and numerous hospital admissions.

The symptoms which occur are –

1. Light headedness
2. Generalised fatigue
3. vertigo
4. blurring of vision
5. difficulty in concentrating
6. palpitations can be experienced
7. anxiety
8. nausea
9. falls

HOW TO DIAGNOSE –

You need to measure the BP 3 times -

10. 5 minutes after lying down
11. 1 minute after standing up
12. 3 minutes after standing

If there is a sudden drop in systolic BP of 20mmHg or greater, a drop in diastolic BP of 10mmHg or greater, then this confirms the diagnosis.


MANAGEMENT –

First line treatment is to stop the medications that are causing this hypotension.
Other treatment technique include lifestyle modifications such as to drink 2-3 litres of water slowly throughout the day; increase salt intake; elevate the head end of the bed at night; use compression stockings when going out; exercise the major muscle groups just before standing up, for example - static gluteal. Increase the consumption of caffeine, salt, and fluids while decrease alcohol consumption.
Advise the patient to avoid quick postural changes, setting up activities for later on in the day, and avoiding stationary standing activities.
Warm temperatures should also be avoided. <>br Swimming is considered to be an ideal exercise for the patient, as the hydrostatic pressure of the water counteracts the hypotension that patient is experiencing. During a PT session, it is essential to monitor a patient's BP before, during, and after the exercise.
Movement changes like to sit on edge of bed for 30 seconds before standing up, count up to 10 once you stand up before you start to move.