Low blood pressure on standing requires medical attention

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It is caused by multiple factors in the nervous and cardiovascular systems

Riyadh: Dr. Hassan Mohamed Sandakji

What some suffer from a rapid drop in blood pressure when standing after sitting, is a relatively common problem and requires searching for the causes and treating them. The drop in blood pressure in the body in those moments not only causes a feeling of dizziness and dizziness, but may sometimes lead to fainting, and it may also be a sign of a disease that requires attention.

– a medical case

This condition is medically called “orthostatic hypotension”, and it may occur when standing up after sitting, or sitting after lying down. Several factors in the nervous system, the circulatory system of the heart and blood vessels, and a number of endocrine chemical compounds are intertwined in the stages of the mechanism for this state of temporary hypotension.

As the US National Institute of Health (NIH) points out, “Orthostatic hypotension is a common condition that affects about 6 percent of the population. This condition is particularly common in the elderly, and affects at least 10 to 30 percent of people in this group. In 40% of patients, the cause of this condition is not found.”

In addition to the attempts of medical researchers to learn more about the mechanisms of this temporary drop in blood pressure, there are other attempts to find out how to take practical means to reduce the chances of it severely in those who suffer from this condition chronically and without clear reason for them.

In the February 9 issue of the journal Heart Rhythm, researchers from the University of Calgary in Alberta, Canada, presented two simple methods that may help patients manage the symptoms of orthostatic hypotension, especially in young women. The researchers reported that some simple physical maneuvers, such as pre-activating the lower body muscles before standing, and tightening the lower body muscles after standing, may lead to countering orthostatic hypotension and reduce its symptoms.

The researchers found that decreases in the average amount of blood pressure, and the suffering of associated symptoms, were significantly reduced by following the application of these simple maneuvers.

Orthostatic hypotension

According to medical sources, orthostatic hypotension is generally a form of hypotension. But it is characterized by that it occurs temporarily when standing up from sitting or sitting from lying down. A person with orthostatic hypotension can feel dizzy and may faint. These are symptoms that usually last for less than a few minutes.

There are two main types of it, one type called long-term orthostatic hypotension. This may indicate the possibility of a chronic health problem, with feeling dizzy when standing up frequently. Therefore, treatment varies from case to case according to the cause of the disease.

The other type is called symptomatic (acute) orthostatic hypotension. This last type is usually caused by something obvious and urgent, such as dehydration of the body in cases of fever, diarrhea or frequent vomiting. As well as the result of lying down or bed rest for a long time. And also with low blood sugar or disturbances in the levels of some salts and minerals in the blood.

And reviewing what patients who suffer from this condition say, the most common symptoms are lightheadedness or dizziness when standing up after sitting or lying down. Some add either blurry vision (blurred eyes), chest pain, headache, shortness of breath, weakness and physical weakness, nausea, mental confusion and poor concentration. Few of them remember suffering from fainting.

It should be noted that orthostatic hypotension differs from POTS, although POTS causes symptoms similar to orthostatic hypotension. Both cause dizziness or fainting when standing.

But along with low blood pressure, postural tachycardia causes the heart rate to increase by 30 to 40 beats per minute within 10 minutes of standing. Localized tachycardia syndrome is also less common than orthostatic hypotension.

In essence, blood pressure is the force with which the blood pushes against the walls of the arteries as it flows through them. It is necessary to understand that a person needs the strength of that blood pressure, in order for blood to flow and flow to the various organs smoothly, continuously, and within rates that do not cause harm to those organs.

A healthy, ideal blood pressure for most people is less than 120 over 80 mm Hg. A reading of less than 90 out of 60 mm Hg is considered a drop in blood pressure.

It is known that when the heart contracts, blood rushes forcefully from the heart towards the arteries for a short time. And then the blood pressure rises, which is measured under the name “systolic pressure” or the high number in the blood pressure reading. When the heart relaxes and stops contracting, a balanced state of “pressure” occurs within the arteries, to ensure the continued flow of blood and its pumping through the arteries to the various organs. This is what is measured under the name “diastolic pressure” or the low number in the blood pressure reading.

– interlocking factors

Several factors contribute to the formation of this balanced state of “pressure” inside the arteries all the time. The most important of these are the elasticity of expansion in the arteries, a number of chemical compounds secreted by the kidneys and a number of endocrine glands, and also the nervous system has another pivotal role in the formation of this balanced state of pressure inside the arteries all the time. Therefore, when a case of “hardening of the arteries,” blood pressure rises.

Orthostatic hypotension is a condition in which systolic blood pressure drops more than 20 mmHg in systolic pressure and 10 mmHg in diastolic pressure, within three minutes of standing, compared to sitting.

The explanation for this is that when a person is sitting or lying down, blood flows easily from the veins in his legs back to the heart. When he stands, it is difficult for the blood in his lower extremities to reach the heart, due to gravity. Therefore, there is little blood available for the heart to pump and send to the organs and muscles, especially the brain. As a result, blood pressure decreases temporarily, dizziness and light-headedness occur, and fainting may occur due to a severe decrease in blood flow to the brain.

Medical sources explain that in normal cases, and to prevent this disorder from occurring, certain cells (baroreceptors in the arteries near the heart and in the neck) sense this drop in blood pressure. Then these baroreceptor cells send signals to centers in the brain, which in turn sends signals to the heart to beat faster and pump more blood, and other signals to the blood vessels to narrow and constrict, and the blood pressure inside them increases.

The result of all this is the return of the stability of the blood pressure and the non-continuation of the decrease in it. That is, normally and in normal conditions, the autonomic nervous system provides compensatory changes in vascular tension, heart rate and cardiac contractility. But in some individuals, this response may be defective or inadequate. Thus orthostatic hypotension occurs when something affects the normal course of action in the body that experiences the expected hypotension upon standing.

For example, when the nervous system is disturbed, it is difficult for blood pressure to keep up with the change in body position and blood flow to the lower extremities due to gravity, when standing after sitting or lying down.

Who are at risk of orthostatic hypotension?

Anyone can develop orthostatic hypotension. These factors increase the risk:

Aging: Doctors «Mayo Clinic» say: «Orthostatic hypotension is common among people 65 years of age or older. Special cells (baroreceptors near the arteries in the heart and neck that regulate blood pressure) may slow down as you age. It may also be difficult for an aging heart to speed up and compensate for drops in blood pressure.”

Anemia or vitamin B12 deficiency.

> Dehydration of the body from fluids, as a result of either diarrhea and vomiting, taking diuretics, not drinking enough fluids, or doing strenuous exercise with excessive sweating.

> Endocrine problems and disorders, including diabetes, thyroid disease and Addison’s disease. In diabetes, low blood sugar may lead to orthostatic hypotension. Diabetes may also cause damage to the nerves that help send signals that regulate blood pressure when the body changes position while standing.

Heart disease, including arrhythmia, heart valve disease, and weak heart failure. Some heart diseases may lead to low blood pressure and a very slow heartbeat. These conditions prevent the heart from responding quickly enough and pumping more blood when standing.

Taking certain medications: High doses of high blood pressure and heart disease medications, such as diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and nitrates. As well as some types of depression treatment.

> Neurological problems and disorders, such as Parkinson’s disease and dementia.

> Pregnancy, especially during the first 24 weeks of pregnancy.

> After eating (postprandial hypotension). This condition is more common among the elderly.

> Prolonged immobility due to illness, including bed rest during pregnancy.

People with orthostatic hypotension may be more likely to have:

> Broken bones or concussions from a fall when feeling dizzy or faint.

Postprandial hypotension, and hypotension 30 minutes to two hours after eating (especially a carbohydrate-rich meal).

> Shock or organ failure if blood pressure remains too low.

> Stroke or heart disease caused by fluctuations in blood pressure.

Supine hypotension, low blood pressure that occurs when lying on the back.

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