Top Things to Know: Orthostatic Hypotension in Hypertensive Adults
Published: January 11, 2024
Prepared by Anne Leonard MPH, BSN, RN
- Orthostatic hypotension (OH) is defined as a sustained reduction in systolic blood pressure of at least 20mmHg or diastolic blood pressure of 10mmHg within 3 minutes of standing and is common among adults with uncontrolled hypertension (HTN) and is frequently cited because of HTN treatment.
- OH is driven by gravitational redistribution of about 300-800 cc’s of fluid to the lower extremities and splanchnic vessels upon standing.
- OH increases with age affecting about 10% of adults 60 – 65 and increases to 15%-30% in adults over age 65. This is partly due to impairments in autonomic reflex with age.
- OH is an independent risk factor of mortality - that is linked to higher hospital admissions. Persons with OH have a higher risk of developing heart failure, atrial fibrillation, coronary heart disease and myocardial infarction.
- There are four clinical presentations for OH or characterizations as described in this paper:
- Classic OH caused by autonomic dysfunction.
- Hypertensive OH caused by reduced diastolic filling due to left ventricular hypertrophy/arterial stiffness.
- Pseudo OH – “threshold effect” (systolic change threshold of 30 mm Hg among patients with hypertension)
- Pseudo OH – measurement error
- Non-pharmacologic approaches to managing OH such as compression garments along with fluid and sodium management considerations are discussed in this statement.
- The effects of antihypertensive treatments on symptomatic OH and the antihypertensive drugs that can be used in adults with symptomatic OH are reviewed in this paper.
- Pharmacologic treatment for specific etiologies such as neurogenic OH, isolated supine HTN in patients with severe neurogenic OH, and hypertension with intermittent hypotensive events are examined in this paper.
- When OH is identified, finding its etiology will be an important first step for clinicians in treating this condition. Non-pharmacological interventions are first-line steps regardless of the etiology. Treatment can be complex and nuanced.
- More research is needed to adequately understand OH and management of it.
Citation
Juraschek SP, Cortez MM, Flack JM, Ghazi L, Kenny RA, Rahman M, Spikes T, Shibao CA, Biaggioni I; on behalf of the American Heart Association Council on Hypertension. Orthostatic hypotension in adults with hypertension:a scientific statement from the American Heart Association. Hypertension. Published online January 11, 2024. doi: 10.1161/HYP.0000000000000236