Orthostatic Hypotension in Women: Low Blood Pressure

What is Orthostatic Hypotension?
Vision going dark when you get up from your couch? There's little reason to panic. Many women experience what is called orthostatic hypotension or prostural hypotension. When people lay down, the body does not have to work as hard against gravity to pump blood all over the body. As a consequence, blood pressure lowers. Suddenly standing up requires the body to activate a number of heart and blood vessel responses to raise the blood pressure to the levels that a standing person requires. If the response lags, there will actually be a drop in blood pressure and this results in an inadequate blood supply to the brain. Therefore, a person with orthostatic hypotension may experience dizziness, changes in vision, and an uncomfortable feeling in the head and neck area upon rising from a lying or sitting position. This condition is common in women and usually not serious or an indication of a larger problem. Typically, it only becomes a medical issue when it results in fainting (also called syncope).

Gender Differences in Orthostatic Hypotension
Orthostatic hypotension primarily affects women. There are also gender differences in the blood pressure to the brain, as well as the body. The brain has additional mechanisms for regulating blood pressure. Woman may experience classic orthostatic hypotension symptoms, but not be diagnosed correctly by some doctors. Doctors in an office setting can only test for this by measuring blood pressure in lying down and then more upright positions and comparing the results.

What You Can Do for Orthostatic Hypotension
You may want to try engaging in any kind of aerobic exercise that will help condition the cardiovascular system. These are things like jogging, biking, and swimming. The outside temperature may also play a role in inducing orthostatic hypotension, so staying aware of the heat outside can help in avoiding this condition. Drinking more fluids (especially water) is the key for many. This will prevent dehydration or boaderline hydration, which will in turn help maintain adequate blood pressure. Along with this increased fluid intake, you can also try to eat more salt. While some people strive to cut down on salt, those with orthostatic hypotension may need to add. The salt will cause your body to hold more fluid. Your doctor can prescribe tablets, if you can't get enough through your diet. The easiest, most direct way to prevent the dizziness associated with low blood pressure is to get up slowly. Whenever you go from a lower position to a higher one, do it in 3 steps, taking 5-8 seconds for each one. For example, when getting out of bed, first sit up in bed, then swing your legs over the edge and sit at the edge, then slowly rise to standing. You can adjust the time you take for each step according to your personal needs; if you are still experiencing the symptoms of hypotension with 5-8 second steps, increase to 10-15 and continue increasing as needed.

Some Orthostatic Hypotension is Caused By Medications
Some medications used to treat other health problems can result in orthostatic hypotension. Two types of medication in particular are antidepressants and anti-hypertension medications. The popular Serotonin Re-uptake Inhibitor antidepressants (like Prozac and most other modern antidepressants) can induce hypotension, although they have less of an adverse effect than the previously used tricyclic antidepressants. Anti-hypertension medications are most often used for the elderly as blood pressure increases with age. Ironically, the use of these medications can sometimes swing blood pressure to the opposite extreme, resulting in hypotension. If you are taking any of these medication and are experiencing the symptoms of hypotension, you may want to talk to your doctor about switching to a different drug, a lower dose, or discontinuing use of the medication altogether.

When to See a Doctor
Most orthostatic episodes are mild and quickly passing. Most orthostatic hypotension does not indicate an underlying disease. But if fainting or near fainting occurs, if it is disrupting to normal activities, if episodes have started suddenly, if the woman is taking a medication, or if it occurs along with other new symptoms, then a doctor's visit is in order. Older, diabetic, hypertensive, depressed, and anxious patients are more likely to be those requiring medical intevention. Low blood pressure can be a symptom of heart or circulatory problems. Rarely, there are neurological problems that underlie orthostatic hypotension. Very rarely, it is part of a larger neurological syndrome. Neurologically based problems can be diagnosed through the use of tilt table testing, in which the patient is tilted up until syncope occurs. Doctors may use medications such as fludrocortisone or a new drug called midodrine for treatment. They may also use the tilt table used to diagnose to gradually increase the patient's tolerance to position changes. All others are addressed by treating the underlying cause.

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