Orthostatic hypotension means that when you are standing ("static") upright ("ortho"), your blood pressure ("tension") falls ("hypo"), and causes you to become dizzy or even pass out. There are several causes for this, including not taking enough fluids and salts, some medications (for example, the tricyclic antidepressants and the anti-hypertensives, of course), and some hormonal problems. However, much of the time, the problem is due to the fact that the nerves are not telling the vessels to close down when you stand up. You may not realize this, but whenever you stand, the blood vessels in the rest of the body must close down, so that blood can continue flowing to the brain. The nerves (specifically, the autonomic nerves) are responsible for this. If they are not working, as sometimes happens in diabetes or in Parkinson's disease, the vessels do not close properly, and result in orthostatic hypotension.
First, a diagnosis must be obtained, to understand the origin and severity of the problem. This will usually include autonomic testing, including blood pressure testing, perhaps some bloodwork, and sometimes some imaging of the brain. Second, some basic simple measures will help greatly:
1) Elevate the head of your bed with 2 bricks under the legs on the head end (pillows don't work). This causes more fluid to remain in your body overnight, so that you are not so dizzy in the morning.
2) Begin water jogging. This means walking in the water 3 times a week with the water level up to your neck. The water exerts pressure on your legs and stomach, causing blood to return more efficiently to the brain. This in turn allows you to do much more exercise without feeling exhausted, and without danger to your brain, toning your muscles, and increasing the efficiency of your vessels in closing down.
3) If you feel dizzy, sit down or lie down immediately, until the feeling passes.
4) Eat frequent small meals, perhaps 6 per day, rather than large meals 2-3 times per day. When you eat, blood goes to the gut, and the amount of blood diverted depends on the size of the meal. If you have trouble getting blood to the brain in the first place, the gut is not where you want more to go. In addition, insulin is released with the meal, and makes the blood pressure lower.
5) Take salt tablets if prescribed: 500 mg tablets each am, to increase the fluid in your body.
6) Wear Jobst stockings, mmHg pressure, thigh high. This sheet consitutes a prescription, because it is signed at the bottom, and you may take it to the store to have this filled. In addition, you should wear an abdominal corset, to keep blood flowing from there back to the brain.
7) Buy an automated blood pressure cuff, and record your blood pressure and pulse when you are lying down, and when you are standing. This should be done at the same time of day every day, particularly when you are changing treatment, to see what effect it has. You should also record your blood pressure lying and standing whenever you have a spell. Finally the "standing time", the time you are able to stand still without developing symptoms should be recorded every morning at the same time, if it is less than 10 minutes. A special sheet will be provided for you to record all of this information.
8) Medications: many are available. By the time you have done all of the measures above, the problem may be resolved, and you may not need medication. However, here are some of the common medications: a) fludrocortisone (Florinef ®) improves vessel response at low dose, and causes fluid retention at high doses. b) midodrine (Proamatine ®) available since 12/95, directly causes the vessels to close down by acting just like the chemical that the nerves would have used to close down the vessels, had they been functionning properly. c) beta-blockers such as propranolol (Inderal ®), prevent the veins from opening excessively, and may also trigger increased standing blood pressure through other unknown mechanisms.
When you are starting a new medication, you can fax us your blood pressure readings and how you are feeling every week or every 2 weeks, and we will either call you or respond by fax as well, if changes are needed.