Definition
The sharp drop in arterial blood pressure values can occur following a quick change in position, from sitting to standing: in this case, we speak of orthostatic hypotension. More precisely, orthostatic hypotension proper occurs when the reduction in blood pressure exceeds 20 mmHg of the maximum pressure and 10 mmHg of the minimum.
Causes
Orthostatic hypotension is essentially caused by the sudden change in position, from sitting / lying down to standing; the condition occurs more often in the elderly, in Parkinson's patients and in hypertensive patients.
Change of lying-up position → recall of blood in the legs → blood stagnation in the legs → inability of the venous system of the legs to oppose the recall of blood + inability to return blood to other anatomical sites → drop in blood return to the heart
- Risk factors: excessive intake of hypotensive drugs, heart deficiency, diabetes, dehydration, degenerative neurological diseases (eg. Parkinson's disease), varicose veins
Symptoms
Symptoms associated with orthostatic hypotension may include: confusion, weakness, blurred vision, fainting, dizziness.
The information on Orthostatic Hypotension - Drugs for the Treatment of "Orthostatic Hypotension is not intended to replace the direct relationship between the health professional and the patient. Always consult your doctor and / or specialist before taking Orthostatic Hypotension - Drugs for the treatment of" Orthostatic hypotension.
Medicines
When orthostatic hypotension is caused by the administration of particular drugs, it is necessary to intervene by modifying the dosage of these, clearly after consulting a doctor. As we have seen, orthostatic hypotension could depend on dehydration, therefore a replenishment of fluids is essential. Among other possible non-pharmacological treatments, the importance of wearing elastic stockings should be remembered in order to facilitate the return of blood to the heart.
As for drug therapy, many drugs, even belonging to different classes, can help relieve symptoms and overcome the disorder; the choice of one drug instead of another clearly depends on the cause that caused the orthostatic hypotension.
In case of orthostatic hypotension, it is advisable to correct eating habits and to prefer some foods rather than others, since they can affect the regulation of blood pressure. A person with or at risk of known orthostatic hypotension should prefer foods such as:
- infusions based on coffee, cola, guarana, maté, black tea, rich in caffeine
In case of hypotension, it is recommended not to drink alcohol, since alcohol promotes the reduction of blood pressure.
The following are the classes of drugs most used in the therapy against orthostatic hypotension, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state health of the patient and his response to treatment:
- Ephedrine (eg. Argotone, Deltarinolo, Rinovit): the drug is a sympathetic-mimetic, indicated for the treatment of orthostatic hypotension. Start therapy with a drug dose of 25-50 mg, to be taken every 3-4 hours . Do not exceed 150 mg per day. Alternatively, it is possible to take the drug also intramuscularly or subcutaneously, at the indicative dosage of 25-50 mg, every 3-4 hours; again, the drug can be taken intravenously, at a dose of 5-25 mg (duration of infusion: 15 minutes). Again, do not exceed the daily dose of 150 mg. Consult your doctor for any clarifications.
- Midodrine (eg. Gutron): belongs to the class of sympathetic / vasopressor drugs, capable of activating the alpha-1 receptors of blood vessels. It causes peripheral vasoconstriction which, consequently, increases the pressure. Indicatively, take 10 mg of active by mouth, three times a day. The doses should not be taken within three hours of each other. Alternatively, the drug can be taken in a single dose of 20 mg, orally. The dose can increase up to 30 mg per day. The drug is usually prescribed for patients with severe orthostatic hypotension who do not benefit from the other drugs. Consult your doctor.
- Noradrenaline (eg. Noradr Con FN): belonging to the class of catecholamines, the drug is indicated to cancel the effects of orthostatic hypotension. It is recommended to start therapy with 2-4 mcg of drug per minute. The maintenance dose is to be taken. determined by the physician based on the severity of the condition and the patient's response to treatment; in general, the maintenance dose ranges from 1 to 12 mcg per minute.
- Phenylephrine (eg Isonephrine, Fenil CL DYN, Triaminic FLU, Nasomixin CM): the drug belongs to the pharmacological class of Sympathomimetics (Alpha-adrenergic agonists). It is also widely used in therapy as a decongestant for the treatment of nasal congestion and rhinitis; the administration of these drugs induces an increase in blood pressure values, decreasing the symptoms accompanying the disorder. hypotension involves taking 2-5 mg of active, every 1-2 hours, as needed, subcutaneously or intramuscularly. For intravenous infusion, initiate anti-hypotensive therapy at a dose of 100-180 mcg per minute. The maintenance dose can range from 40 to 60 mcg per minute. Alternatively, take 0.5 mcg / kg per minute. Consult your doctor.
- DL-threo-dihydroxyphenylserine (eg Droxidopa): sympathetic-mimetic drug useful for increasing the endogenous synthesis of norepinephrine. The drug is not marketed in Italy.
- Fludrocortisone (eg. Florinef): synthetic mineralocorticoid used in therapy also to increase pressure in the context of orthostatic hypotension. Taken at a dosage of 0.1-0.5 mg / day it seems to positively increase blood pressure, stimulating peripheral vasoconstriction It is recommended to take a correct dose of sodium, in association with the therapy with this drug. For the elderly patient and / or affected by myocardial alterations, the administration of Fludrocortisone is not always recommended, since it increases the risk of heart failure.
- Desmopressin (eg. Minirin / Ddvap): it is a synthetic analogue of vasopressin, capable of carrying out the same therapeutic activities but with a longer duration of action and with fewer side effects. By increasing the plasma volume, the drug reduces the "sodium excretion with the urine, therefore the volume of circulating blood increases, as does blood pressure. As a guideline, take 0.2-0.6 mg of active, once a day, before going to bed.
Here are some behavioral rules, useful for avoiding orthostatic hypotension crises:
- Sleep with the head of the bed raised
- Don't stay upright for too long
- Change position (from lying to standing) slowly
- Regularly engage in moderate-intensity exercise
By applying these simple general guidelines, the patient, especially when elderly, can prevent relapses of orthostatic hypotension.
Other articles on "Orthostatic Hypotension - Medicines to Treat" Orthostatic Hypotension "
- Orthostatic hypotension: diagnosis and treatment
- Orthostatic hypotension
