In an interview, Dr. Gibbons suggested that orthostatic hypotension may be "a presymptomatic sign of Parkinson's, dementia, and other autonomic nervous system disorders" for which drug treatments are currently being studied in hopes of slowing its progression.
Occasionally, orthostatic hypotension can have a less threatening cause, such as: B. Dehydration or overheating. Or it can be precipitated by a drop in blood sugar or a large meal, especially one accompanied with alcohol. However, if heart, neurological, or endocrine disorder is the underlying cause, orthostatic hypotension is likely to be more common.
Certain medications, including those used to treat high blood pressure, depression, psychosis, erectile dysfunction, Parkinson's disease, urinary frequency in men, and muscle cramps, can increase the risk of a sharp drop in blood pressure when standing. Dr. Gibbons said, for example, that diuretics used to treat high blood pressure can be "problematic" and could be replaced with drugs that are less likely to cause a drop in blood volume that affects the body's ability to adapt to standing.
Dr. Lewis A. Lipsitz, geriatrician and director of the Marcus Institute for Aging Research in Boston, said people with particularly high blood pressure are more prone to orthostatic hypotension because high blood pressure affects the heart's ability to pump blood and thickened the blood vessels that can then . t constrict and impair kidney function. "The higher you are, the harder you fall," he said.
"Most doctors don't look for orthostatic hypotension unless the patient complains of dizziness or lightheadedness when standing," said Dr. Juraschek. However, the American Diabetes Association recommends screening because neurological damage caused by diabetes is a common risk factor. Although a large community-based study found that 5 percent of middle-aged people had orthostatic hypotension, it was found that 25 to 30 percent of diabetics had the disorder.
In a joint statement, the American Heart Association and the American College of Cardiology recommended screening for orthostatic hypotension before and after starting drug therapy to lower blood pressure. People who are treated with drugs that are effective to lower blood pressure are particularly at risk.
Dr. Lipsitz said, "Any patient taking medication to lower blood pressure should be checked for orthostatic hypotension at routine doctor visits." He suggested that patients lie down for three to five minutes, then get repeated blood pressure checks for the first 20 to 30 seconds after one minute and again after getting up for three minutes. He explained that when a person gets up "half a quarter of the puddles of blood in the legs and abdomen," but in the elderly, the increase in heart rate and blood vessel constriction required to compensate for this is less effective.