In the general population, orthostatic hypotension predicts cardiovascular and non-cardiovascular mortality, but not cancer-related mortality (5).
Those with orthostatic hypotension survived a mean of 3.19 years after examination 4 (range 0 to 4.75 years), whereas those without orthostatic hypotension survived a mean of 3.37 years (range 0 to 4.83 years).
Older individuals may have lower intravascular volumes, venous insufficiency, and impaired baroreflexes. As a result, orthostatic hypotension (oHypo) is not uncommon, and is associated with worse clinical outcomes including myocardial infarction, stroke, heart failure, cognitive impairment, and mortality [1–4, 6–8].
A drop of 20 millimeters of mercury (mm Hg) in the top number (systolic blood pressure) within 2 to 5 minutes of standing is a sign of orthostatic hypotension. A drop of 10 mm Hg in the bottom number (diastolic blood pressure) within 2 to 5 minutes of standing also indicates orthostatic hypotension.
Orthostatic hypotension had no effect on all cause and cause specific mortality. Over a follow-up of 3.47±1.87 years 249 patients (52.8%) had died 83 of whom (33.3%) had OH. Age-adjusted mortality rates in those with and without OH were 13.4 and 15.7 per 100 person-years, respectively.
Conclusions: Orthostatic hypotension is present in about one quarter of outpatients with stroke, and coronary artery disease appears to be a risk factor.
What is the life expectancy of POTS? People with POTS have a normal life expectancy. The condition doesn't decrease life expectancy.
In people with orthostatic hypotension, hypoperfusion to other organs contributes to an increased risk of life-threatening health problems, including heart attack or heart failure, a heart rhythm abnormality called atrial fibrillation , stroke, or chronic kidney failure.
Causes of orthostatic hypotension
Fever. Prolonged bed rest. Excessive amounts of alcohol. Some medications, such as some diuretics or antihypertensive (high blood pressure) medications.
Along with a drop in blood pressure, POTS causes a heart rate increase of 30 to 40 beats per minute within 10 minutes of standing. With orthostatic hypotension, your heart rate doesn't increase.
Orthostatic hypotension is a common cause of transient cerebral hypoperfusion that is associated with subclinical brain disease, as well as increased risk of stroke.
OH is easy to diagnose; however, it is often overlooked in clinical practice because it is asymptomatic in normal conditions. The risk factors associated with OH include older age; use of antihypertensive drugs; and comorbidities such as hypertension, cardiac failure, and kidney disease.
Postprandial orthostatic hypotension
Tell patients to take frequent, small meals and reduce alcohol intake. Hot drinks, hot foods, and meals rich in carbohydrates may be troublesome.
Loss of fluid within the blood vessels is the most common cause of symptoms linked to orthostatic hypotension. This could be due to dehydration brought about by diarrhea, vomiting, and the use of medication, such as diuretics or water pills.
Progressive orthostatic hypotension is characterised by a slow progressive decrease in systolic blood pressure (together with compensatory heart rate increases) upon the assumption of a standing position.
Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age.
The drop in blood pressure may be sudden (vasovagal orthostatic hypotension), within 3 minutes (classic orthostatic hypotension) or gradual (delayed orthostatic hypotension).
Previous studies have revealed an increased prevalence of orthostatic hypotension with age. In community dwelling individuals >65 years of age, its prevalence is approximately 20%; in those >75 years of age it is as high as 30%.
This suggests that emotional stress can induce hypotension, probably through hyperventilation, in subjects with autonomic failure. An important feature of autonomic failure is orthostatic hypotension, giving rise to sensations of light headedness or frank syncope following standing up or during prolonged standing.
The symptoms of POTS include but are not limited to lightheadedness (occasionally with fainting), difficulty thinking and concentrating (brain fog), fatigue, intolerance of exercise, headache, blurry vision, palpitations, tremor and nausea.
POTS is a serious condition that can significantly affect the quality of life, but it's not usually life-threatening. There is no permanent cure or standardized treatment protocol available for POTS, but various treatment options are available to manage the disease conservatively.
Providers should educate patients on what orthostatic hypotension is, what causes it, and what makes it worse. Symptoms may worsen with prolonged standing, eating large meals, dehydration, drinking alcohol, a hot environment, straining, and taking hot baths or showers.
A less common cause of ischemic stroke occurs when blood pressure becomes too low (hypotension), reducing blood flow to the brain. This usually occurs with narrowed or diseased arteries. Low blood pressure can result from a heart attack, large loss of blood or severe infection.
The risk of stroke increases continuously above blood pressure (BP) levels of approximately 115/75 mm Hg. Since the association is steep, and BP levels are high in most adult populations, almost two thirds of stroke burden globally is attributable to nonoptimal BP (ie, >115/75 mm Hg).