Orthostatic hypotension, also known as “orthostatic hypotension”, refers to the rapid drop in blood pressure when the human body changes suddenly from a lying, sitting or squatting position to a standing position. The specific criterion of judgment was a decrease in systolic blood pressure ≥20 mmHg, or a decrease in diastolic blood pressure≥ of 10 mmHg.
Postural hypotension has a high incidence among the elderly, with about 30% of the elderly worldwide suffering from the disease, and among elderly outpatients, the prevalence reaches 35.2%.
When the human body is converted from a sitting or lying position to a standing position, under the action of gravity, blood is concentrated in the circulatory system of the lower limbs and spleen, which temporarily reduces blood return to the veins, leading to a decrease in the heart’s output and a decrease in blood pressure. Under normal circumstances, the human body initiates a complex set of regulatory mechanisms to maintain the stability of blood pressure. But when this regulation is inadequate, it triggers orthostatic hypotension.
Common causes of orthostatic hypotension include impaired autonomic reflexes, hypovolemia, and adverse drug reactions. Among them, adverse drug reactions are an important factor contributing to orthostatic hypotension in the elderly.
Common drugs that may trigger orthostatic hypotension are: nitrates such as nitroglycerin, isosorbide mononitrate, etc.; commonly used antihypertensive drugs such as amlodipine, nifedipine, furosemide, etc.; hypoglycemic drugs such as dapagliflozin, empagliflozin, etc.; antipsychotic drugs such as clozapine, olanzapine, etc. Because older adults tend to take multiple medications at the same time, they are at a relatively higher risk of developing orthostatic hypotension.
Orthostatic hypotension can be prevented and treated, specifically from the following aspects:
First, Be careful to move slowly when you get up. Sudden standing should be avoided, first from the recumbent position to the seated position and rest for 30 seconds, then from the seated position to the standing position and rest for 30 seconds. Second, To “screen for medication that predisposes to orthostatic hypotension”. If you are taking this type of medicine, do not stand up suddenly when you get up, it is best to sit still for a while. Again, Preventable with postural training. For example, squatting and crossing legs can tighten leg muscles and reduce blood stasis in the lower limbs, thereby reducing the risk of orthostatic hypotension, but this method is not suitable for patients with balance problems. Finally, Treatment with the aid of drugs is also possible. Clinically, physicians will consider volume expanders and vasopressor drugs, such as midodrine, droxidopa, and others, depending on the patient.
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