Neurogenic Orthostatic Hypotension- Causes, Diagnosis and Treatment

Introduction

Neurogenic orthostatic hypotension is a common condition. Mostly the older age group is affected by this condition. This occurs in bedridden individuals. This condition also occurs in teenage groups. Teenage individuals having growth spurts can develop orthostatic hypotension. Neurogenic orthostatic hypotension occurs more frequently, and the symptoms are more severe in the morning.

What Is Neurogenic Orthostatic Hypotension?

In this condition, the autonomic system, which is essential for controlling automatic body functions, cannot regulate blood pressure when the individual changes their position from sitting to standing. In this condition, there is a reduction in blood pressure. The normal systolic to diastolic blood pressure is 120 by 80 millimeters of mercury. In orthostatic hypertension, the blood pressure is reduced to 100 by 70 millimeters of mercury. This orthostatic hypotension also occurs while performing other everyday activities like lifting weights and defecation.

What Are the Signs of Neurogenic Orthostatic Hypotension?

The symptoms of neurogenic orthostatic hypotension are as follows:

• Individuals with this condition experience reduction in blood pressure when standing up, changing positions, or standing for a long duration.

• Dizziness, lightheadedness, and the feeling that they are about to black out.

• Chest pain.

• Weakness.

• Heart palpitations.

• Nausea.

• Shortness of breath.

• Blurred vision.

What Are the Causes of Neurogenic Orthostatic Hypertension?

Disorders that affect the autonomic nervous system can impair the adjustment of blood pressure, leading to orthostatic hypotension. In addition, these disorders often have a strong genetic component and may affect multiple family members. Neurogenic orthostatic hypotension often occurs along with nervous system disorders such as:

• Parkinson's disease.

• Dementia with Lewy bodies.

• Multiple system atrophy.

• Pure autonomic failure.

• Diabetes.

• Guillain-Barré syndrome.

• Dopamine beta-hydroxylase deficiency.

• Infections that lead to disturbances in nerve function (neuropathy).

What Are the Diagnostic Tests for Neurogenic Orthostatic Hypotension?

The following diagnostic tests can be done for neurogenic orthostatic hypotension:

• Blood Pressure Monitor: Blood pressure monitoring entails taking readings both when seated and standing. For instance, orthostatic hypotension is indicated by a 20-millimeter of mercury decrease in the top segment, which is systolic blood pressure, within two to five minutes after standing. Also indicative of orthostatic hypotension is 10 millimeters of mercury decline in diastolic blood pressure between two to five minutes of standing.

• Blood Tests: Blood tests are necessary to determine the red blood cell count and lowered blood sugar levels.

• Echocardiogram: This is done to check the heart-pumping action.

• Electrocardiogram (EKG): This is done to test the alterations of the heart rhythm.

• Exercise Stress Test: In this test, the heart rate is measured during physical exercise.

• Tilt Table Test: The heart rate, rhythms, and blood pressure are measured while the patient lies on the table. The table movement is from horizontal to vertical.

What Is the Treatment for Neurogenic Orthostatic Hypotension?

Orthostatic hypotension treatments can vary depending on the cause, such as:

• Addressing the underlying illness or condition that is producing orthostatic hypotension.

• Adjusting the dosage of an orthostatic hypotension-causing medication or switching to a different medication.

• If they are on bed rest, get out of bed.

• The blood pressure can be kept from dropping by preventing blood from collecting in the legs as one stands up. The absence of autonomic control in such circumstances is compensated mechanically by compression stockings and other clothing. Research carried out by the aerospace sector has provided valuable information regarding this technique for treating neurogenic orthostatic hypotension.

• Taking in fluids and salt if they have dehydration.

• Neurogenic orthostatic hypotension is well-managed by drinking water and elevating blood pressure by increasing blood volume. Preemptive water consumption might raise blood pressure more than medication can. Within 20 minutes of consuming 480 milliliters quickly, increases of nearly 40 millimeters of mercury in systolic pressure have been seen. This strategy works best for multiple system atrophy (MSA) patients when simple water is used instead of other watery liquids.

• If there is no history of renal illness, it is advised for patients with neurogenic orthostatic hypotension to eat a high-salt diet to elevate their blood pressure. Before making any dietary changes, consult their doctor.

• To counteract the effects of neurogenic orthostatic hypotension's low blood pressure, it is possible to raise the head of the bed by ten to thirty degrees while one sleeps. However, before seeing any observable results, patients might need to practice this consistently for a few weeks.

• Crossing the legs by reducing circulation to the legs and keeping the head's blood pressure and volume higher can aid with orthostatic hypotension.

What Medications Are Prescribed for Orthostatic Hypotension?

Orthostatic hypotension sufferers rarely require medication to raise blood pressure and volume. These drugs consist of:

• Droxidopa.

• Erythropoiesis-stimulating agents (ESAs, such as Procrit or Epogen).

• Desmopressin (Nocdurna or DDAVP).

• Octreotide (Bynfezia Pen or Mycapssa).

• Fludrocortisone.

• Midodrine hydrochloride.

• Pyridostigmine (Mestinon or Regonol).

What Are the Consequences of Drugs Used to Treat Orthostatic Hypotension?

The side effects of the drugs which are used to treat orthostatic hypotension are as follows:

• Numbness.

• Itching.

• Headaches.

• Swelling.

• Reduction in potassium levels.

• Heart failure.

What Are the Complications of Orthostatic Hypotension?

People who experience orthostatic hypotension may be more vulnerable to the following:

• Falls, when they feel lightheaded or faint, might result in fractured bones or concussions.

• Low blood pressure with postprandial hypotension thirty to two hours after a meal (particularly a high-carbohydrate meal).

• If blood pressure drops too low, there could be shock or organ failure.

• Variations in blood pressure can cause a stroke or heart disease.

• Hypotension in the supine position refers to low blood pressure while lying down.

How to Prevent Neurogenic Orthostatic Hypotension?

Do not bathe or shower in water that is too hot; keep the temperature normal.

• Hydration:Limit alcohol intake, drink plenty of water, and clear up filling, high-carbohydrate meals.

• Do Not Lie Flat: Use more pillows or tilt the mattress to raise their head at night.

• Preparation Before Standing: After sitting or lying down, they give themselves more time to rise into a standing position. Provide them with a solid object to grip when they stand up.

• Exercise the Muscles:If they stand for a long time, they march on their feet. Use isometric exercises to elevate blood pressure before standing (squeeze a soft rubber ball or cloth, or clench and release your hands).

• Increase Blood Flow and Pressure: Remember to wear belly binders or compression socks (elastic that compresses the abdomen).

Conclusion

Neurogenic orthostatic hypotension, particularly in the elderly, is linked to increased morbidity and can significantly reduce patients' quality of life. Neurogenic orthostatic hypotension is a significant cause of disease burden and a decline in quality of life. Hence proper management and immediate treatment are necessary for this condition as it increases the risk of falls and other serious injuries.