Orthostatic hypertension

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 22, 2016
StartDiseasesOrthostatic hypertension

Orthostatic hypertension is a condition that causes a temporary increase in blood pressure upon standing. Also called postural hypertension, this condition usually does not have lasting effects after the initial feeling of lightheadedness passes, though it can be symptomatic of serious underlying conditions.

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Definition & Facts

Postural hypertension is a condition that causes the systolic blood pressure to rise when moving to a standing position. Typically, the systolic blood pressure must rise by 20 mmHg (millimeter of mercury) to obtain a diagnosis of orthostatic hypertension. Both chronic and acute or temporary conditions are possible.

Orthostatic hypertension is usually linked to an underlying health issue. Associated conditions include diabetes mellitus, pheochromocytoma, brain ischemia, and mast cell activation syndrome. It is more common among those over the age of 40.

Symptoms & Complaints

The most common symptom of orthostatic hypertension is feeling lightheaded or dizzy after standing. The dizziness can last from a few seconds to several minutes but is typically temporary.

Fainting, nausea, and confusion are also symptoms of the condition. Fainting is a serious symptom of postural hypertension, and anyone who faints should consult a medical professional for treatment. Changes in vision are common. Some blurred vision, tunnel vision, and grey outs, or vision loss without losing consciousness, may occur immediately after standing.

Cardiovascular changes are also common and can include chest pain and increased heart rate. Additional symptoms may include headache, weakness, and extreme fatigue. Usually, symptoms occur immediately after standing, but some people experience symptoms several minutes after standing up. The symptoms of postural hypertension may be more intense after sitting for a long period of time.

Some people with orthostatic hypertension have difficulty exercising. During exercise, the person may begin to feel dizzy. This can greatly decrease the person's ability to participate in a regular exercise routine, which can worsen one's overall health.

Causes

Orthostatic hypertension has a variety of causes, including poor circulation that results from sitting for long periods of time. When sitting, blood pools in the extremities, such as the lower legs. As a result of blood pooling, there is less blood pumping through the heart. Upon standing, the pooled blood enters the main circulatory system, and the heart has to work harder to move the blood through the body. This sudden change in the amount of blood in the circulatory system causes a significant rise in heart rate (tachycardia) and blood pressure (hypertension).

Postural hypertension can be caused by illnesses, dehydration, and overheating, such as raising the body temperature by sitting in a hot tub for an extended amount of time. Some conditions, such as heart disease and diabetes mellitus, can cause postural hypertension.

Other causes include smoking, which reduces the heart's ability to pump blood through the body effectively, and neurological disorders. Some people with diseases affecting the autonomic nervous system such as Parkinson's disease and diabetic neuropathy may be affected by a related condition called orthostatic hypotension in which a person's blood pressure drops upon standing.

Diagnosis & Tests

The diagnosis of orthostatic hypertension can vary. The most common test used to determine the presence of the condition includes taking the person's blood pressure several times. For instance, a nurse or doctor may take blood pressure readings while the person is lying down. After several moments, the person stands up and a second blood pressure reading will be taken. A final blood pressure reading occurs after the person has been standing for a short time.

The tilt table test is also an option to diagnose orthostatic hypertension. During the tilt table test, the person lies on an adjustable table, and the table is tilted into different positions while blood pressure readings are taken. Blood pressure readings may be taken manually by a medical professional, or the readings may be taken at regular intervals using an automatic monitor. Generally, a diagnosis is made when changing positions causes a significant change in the systolic blood pressure.

Blood tests are usually recommended to rule out diseases such as heart disease, high cholesterol (hypercholesterolemia), and diabetes mellitus. Based on the blood test and the results of the blood pressure readings, additional testing may be required. For instance, people with high cholesterol levels may need tests to rule out heart disease.

Treatment & Therapy

Treatment and therapies for postural hypertension vary based on the cause of the condition. Some people may begin a gradual exercise program to improve their overall health, which helps improve circulation while controlling blood sugar and reducing cholesterol levels. If heart disease is present, a low-sodium, low-cholesterol diet is usually recommended to help improve overall health while reducing cholesterol levels.

Along with a healthy diet, people with orthostatic hypertension should drink the recommended amount of water each day. Water helps increase the amount of blood in the body for improved circulation, resulting in fewer symptoms when moving to a standing position.

Treatment for underlying diseases is also necessary for some people. Prescription medications are commonly provided to treat conditions that contribute to postural hypertension. Those with high stress levels may receive treatments designed to reduce or manage their stress, such as psychotherapy, meditation, and yoga. People who experience blood pooling in the extremities can use compression garments to improve circulation, which helps reduce the symptoms of postural hypertension.

Prevention & Prophylaxis

Eating a healthy diet, exercising regularly and avoiding caffeine and tobacco products can reduce the risk of developing orthostatic hypertension. Other ways to prevent this condition include managing diabetes with a combination of medicines and healthy lifestyle choices.

People with high-stress lifestyles can begin using stress management techniques to reduce the risk of developing stress-related health conditions. Stress management techniques can vary, but typically includes participating in calming activities. The activities can range from meditation to gardening, kickboxing and painting.

Most people with orthostatic hypertension experience fewer symptoms with time. Symptoms also lessen when underlying diseases are treated with the proper medications and therapies. Seeking a medical evaluation as soon as symptoms appear is the best way to prevent worsening symptoms.