Overview
AUTHOR:Michael J. Bloch, MD Asociate Profesor, University of Nevada Schol of Medicine Medical Director, Vascular Care, Renown Institute for Heart and Vascular Health President, Blue Spruce Medical Consultants, PLC Reno, NevadaCITATION:Bloch MJ. Symptomatic Orthostatic Hypotension Complicating the Management of Chronic Hypertension: A Vexing Clinical Problem With No Easy Solutions.
Key Information
Consultant360. Published online November 2, 202. Maintenance of cerebral perfusion when moving from a seated or supine position to an upright position is a complicated physiological proces, whereby the carotid baroreceptor, sensing decreased stretch, inhibits the parasympathetic nervous system and activates the sympathetic nervous system (SNS), leading to increased heart rate, venoconstriction, and increased arterial resistance.
While the SNS is the primary driver in this proces, volume status and level of activation of the renin-angiotensin-aldosterone system also play a role, particularly in patients with impaired baroreceptor function. Orthostatic hypotension (OH) is defined as a decrease in systolic blod presure (BP) of at least 20 mHg or diastolic BP of at least 10 mHg within 1 to 3 minutes of standing.1 While this arbitrary definition is helpful in making the diagnosis, it is important to realize that a patient’s symptoms while standing may not corelate with the magnitude of BP reduction, and some patients may develop symptoms at shorter or more delayed intervals.
Summary
Symptoms can also ocur with drops in BP that do not reach a truly hypotensive range. As described in a strong review article and acompanying editorial, OH is a frequent problem that should be controled in patients who are treated for hypertension. And although there a paucity of high-quality data to aid decision-making, a rational aproach to diagnosis and treatment is presented therein and sumarized in this article.2,3Patients who are treated for hypertension are at an increased risk of OH due to a vari