What is orthostatic hypertension

Orthostasis Syndrome

Synonyms: orthostatic hypotension, orthostatic dysregulation
English: postural hypotension

1 definition

The Orthostasis Syndrome is a regulation disorder of blood pressure that occurs when changing to the upright body position (orthostasis).

2 physiology

Normally, the organism counteracts the drop in blood pressure caused by orthostasis with the orthostasis reaction. Orthostasis syndrome occurs when this counter-regulation of the body does not work properly.

3 forms

Based on the results of the Schellong test, a distinction is made between the following forms:

Postural orthostatic tachycardia syndrome (POTS) is a special form. Within 10 minutes of getting up, the heart rate increases by at least 30 / min (40 / min for children) or absolutely to> 120 / min. There is no significant drop in blood pressure (RRsyst <20 mmHg, RRdiast <10 mmHg). The exact pathogenesis is currently (2020) unclear. It mainly affects young women.

4 symptoms

Typical symptoms of orthostasis syndrome include:

5 diagnostics

The Schellong test, which is very easy to carry out, or the tilting table test can be used to objectify fluctuations in blood pressure.

6 therapy

In the case of orthostasis syndrome, the patient should be informed about the diagnosis and preventive measures. If the underlying cause is known, it can be treated if necessary. Drugs that promote hypotension are avoided (e.g. diuretics). Ensure that you drink enough water (e.g. at least 2 l / d) and that you have a supply of table salt. Regular endurance training is also helpful.

Circulatory isometric exercises during the process of getting up are helpful in overcoming hypotension, which usually occurs in the morning. By activating the lower leg muscles in the calf area, the venous return flow can be activated while lying down. A two-minute sitting phase can also be inserted between lying down and getting up.

Switching to a cold environment (opening the bedroom window) is also effective. Cold causes vasoconstriction and also increases venous return. Drinking strong coffee (caffeine) can also be considered.

If the general measures are inadequate, fludrocortisone can be used (e.g. 0.1–0.3 mg / day p.o. for 3 days, then dose reduction to 0.05–0.1 mg p.o. after treatment response). The maximum duration of therapy is 2 months. The alpha-1 sympathomimetic midodrin is only used in severe individual cases.

Note: This dosage information may contain errors. The dosage recommendation in the manufacturer's information is decisive.