Orthostatic Hypotension

Abstract

Orthostatic hypotension (OH) is a common cardiovascular disorder, with or without signs of underlying neurodegenerative disease. OH is diagnosed on the basis of an orthostatic challenge and implies a persistent systolic/diastolic blood pressure decrease of at least 20/10 mm Hg upon standing. Its prevalence is age dependent, ranging from 5% in patients <50 years of age to 30% in those >70 years of age. OH may complicate treatment of hypertension, heart failure, and coronary heart disease; cause disabling symptoms, faints, and traumatic injuries; and substantially reduce quality of life. Despite being largely asymptomatic or with minimal symptoms, the presence of OH independently increases mortality and the incidence of myocardial infarction, stroke, heart failure, and atrial fibrillation. In this review, we outline the etiology and prevalence of OH in the general population, summarize its relationship with morbidity and mortality, propose a diagnostic and therapeutic algorithm, and delineate current challenges and future perspectives.

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

“…Gravity‐induced pooling of intravascular volume in the lower extremities is detected by arterial baroreceptors (carotid and aortic) and low‐pressure baroreceptors (predominantly in the right atrium). These receptors trigger vasoconstriction and increased heart rate, resulting in BP stabilization with standing 35. Consequently, vascular stiffness (a risk factor for CVD) is associated with reduced responsiveness to shifts in intravascular volume, although this relationship is not necessarily causative 36.…”

Blood pressure circadian rhythms and adverse outcomes in type 2 diabetes patients diagnosed with orthostatic hypotension

“…Gravitational changes lead to decreased venous return, reduced cardiac output and resultant decreased BP. It was reported in the literature that the prevalence rate of OH ranged from 5 to 30%1, 4. Compared with normal individuals, the rate of OH is higher in diabetes patients1, 14.…”

“…OH can also be asymptomatic if the rate of decrease of BP is low enough as the patient changes position. OH can be a manifestation of diabetic autonomic dysfunction, and can lead to an increased risk of syncope, cardiovascular diseases and severe adverse outcomes2, 3, 4.…”

A New Player in Circulatory Adaptation to Orthostatism

“…Treatments are not always satisfactory. 4,5 The sympathetic nervous system (SN) plays a major role in circulatory adaptation to orthostatism. The system can indeed be activated quickly through arterial baroreceptors and act quickly through noradrenaline release increasing arteriolar resistance and heart rate and restoring cardiac output and organ perfusion pressure.…”

“…Other vasoconstrictor systems are involved, like the renin-angiotensin system, which is physiologically related at its 2 ends, control of renin secretion and action of angiotensin II to the SN, and vasopressin which acts more on the long term. 4 Impairment of SN activity is a key pathogenic feature in most, if not all orthostatic syndromes, such as those observed in neurological diseases, uncontrolled diabetes mellitus with peripheral neuropathy, and during treatment with sympatholytic drugs, as well as in OH without a definite, recognizable cause and called idiopathic.…”