How To Treat Orthostatic Hypotension In The Elderly

Definewhat is orthostatic hypotension OH Cite some common -and some less common but important -reasons for chronic OH in the elderly. The management of orthostatic hypotension in patients with Parkinsons disease should always start with patient education and nonpharmacological treatment.

Features Of Neurogenic And Non Neurogenic Orthostatic Hypotension Download Table

The treatment of orthostatic hypotension involves a multistep approach including identifying the cause and implementing interventions in the hopes of preventing fall-related trauma as well as increasing function and overall quality of life.

How to treat orthostatic hypotension in the elderly. High blood pressure is often seen as a part of growing older. How to treat hypertension in patients with orthostatic hypotension. Ensure the patients concurrent drug therapy is stabilised and there are no contra-indications to treatment options for orthostatic hypotension 3.

Nonpharmacologic Treatment Options for Orthostatic Hypotension. Patients with isolated supine hypertension can be treated with bedtime doses of short-acting antihypertensives. Orthostatic hypotension OH is a common condition characterized as a drop in blood pressure that occurs when a person stands up.

OH can cause lightheadedness dizziness or even causing a person to faint. Orthostatic hypotension is a common problem among elderly patients associated with significant morbidity and mortality. By definition the drop in blood pressure must be greater than 20mm Hg of mercury in systolic BP and.

While acute orthostatic hypotension is usually secondary to medication fluid or blood loss or adrenal insufficiency chronic orthostatic hypotension is frequently due to altered blood pressure regulatory mechanisms and autonomic dysfunction. Midodrine is recommended as a secondline option alone or in combination with for example fludrocortisone. Eat foods such as clams trout salmon milk yogurt ham fortified cereals and eggs are enriched in Vitamin B12.

Hypotension is the term for low blood pressure. Increased water and salt ingestion. Hypotension Low Blood Pressure in the Elderly.

Early morning orthostatic hypotension. Fludrocorti-sone is a synthetic mineralocorticoid that increases BP by causing sodium reten-. Shift from supine to an erect position in gradual stages.

Ensure that patient is aware of risks and benefits of medication. Treatment of OH in the hypertensive patients should focus foremost on the removal of drugs that can worsen OH including ones that are easily overlooked such as tamsulosin tizanidine sildenafil trazodone and carvedilol. The risk of developing essential hypertension high blood pressure due to unknown causes increases after the age of 40 years.

Be careful on awakening. Orthostatic hypotension OH is associated with increased co-morbid conditions in older patients. Cite pharmacologic and non-pharmacologic treatmentsthat may be tried to treat OH.

Postprandial orthostatic hypotension common. Drug therapy should be reserved for symptomatic patients who do not get benefit from nonpharmacological management. Pharmacological Treatments Many drugs have been tried to treat OH.

In elderly patients with orthostatic hypotension related to deconditioning an exercise regimen comprising swimming recumbent biking or rowing might lead to disappearance of symptoms. Unlicensed off-label medicine on fludrocortisone for orthostatic hypotension. Most older adults are therefore using chronic high blood pressure medication for decades thereafter.

Elevate the head of the bed reducing nocturia Drink two cups of cold water 30 minutes before arising. Two commonly used drugs are fludro-cortisone and midodrine. Test for postprandial hypotension which can be treated with acarbose without increasing baseline blood pressure Avoid fludrocortisone Favor approaches that do not worsen supine BP abdominal binder or are short acting 16 oz water bolus.

Symptoms can also be subtle or absent. Undertake the necessary testing to confirm a diagnosis of orthostatic hypotension 2. Orthostatic hypotension also called postural hypotension is a sudden fall in blood pressure that occurs when you stand up quickly.

They are also contraindicated in patients with significant skin ulcers. Normalization of blood pressure generally improves both orthostatic and postprandial hypotension. Pharmacological treatment with fludrocortisone firstline see the NICE evidence summary.

Cardiovascular Safety Considerations In The Treatment Of Neurogenic Orthostatic Hypotension American Journal Of Cardiology