Postural hypotension: Dizzy spell when you stand up?

What is postural hypotension?

Circulation


Owen Wiseman
@AVogel_ca


20 June 2018

Many hard workers across the country feel the grogginess as they rouse from bed, moving from sleeping to sitting…and eventually standing. Waking up is often accompanied by a heaviness as our cells begin to stir, ready to meet the challenges of the day.

What if that heavy feeling were replaced by lightheadedness and lying back down is the only solution?

What is postural hypotension (PH)?

Formally known as orthostatic hypotension, PH is a sudden drop in blood pressure that occurs when you switch positions – most commonly from lying to sitting or standing. It can happen to all of us the odd time, lasting for a few minutes and usually isn’t a sign of concern. However, chronic episodes of PH can signal far more serious concerns and warrant a visit to your primary care provider.

Why does this happen to me?

The cardiovascular system is a well-oiled machine when it comes to monitoring blood pressure and making the necessary changes to ensure homeostasis is maintained. When you stand, 300-800mL of blood pools in your lower limbs due to gravity. Like a hose, the blood vessels are made of a material with a moderate ability to stretch. When all of this blood enters the limbs, special receptors known as baroreceptors detect the distention of the vessels as they stretch to accommodate the extra blood. Elsewhere around the body, the blood volume has decreased and therefore requires additional blood. The baroreceptors here also respond to the decreased stretch and send signals to the brain to increase blood pressure and cardiac output.

In some cases, these baroreceptors fail to respond to the changing pressures, so the blood pressure in the upper body and the head remains low leading to the dizziness, blurred vision, confusion, and potential fainting.

What kind of situations cause these receptors to fail?

Dehydration

Staying hydrated is incredibly important when it comes to maintaining blood volume. We’re very fortunate in Canada that many households, ranging from 66% in New Brunswick to 98% in Saskatchewan are connected to municipal water supply, with 59% of households reporting they drink tap water. Reaching a state of dehydration means you lack enough blood volume to keep cells nourished, encourages the formation of kidney stones, leads to constipation, and increases the risk of PH.

Imagine a vehicle accelerates rapidly, all of the moving components in the engine initially try to keep up, but everything is happening so quickly that the engine can’t manage and the vehicle crashes. Much like a weak engine, an abnormally low blood pressure or heart rate means your body cannot pump the blood fast enough to accommodate the change in pressure when you switch positions.

We’re also looking at you alcohol.

Indulging in a drink…or three…won’t help your risk of PH as the ‘liquid courage’ causes a constriction of the blood vessels. This makes it more difficult for the blood to get where it needs to be. Additionally, alcohol tends to cause dehydration as it decreases the production of an agent known as anti-diuretic hormone (ADH). ADH encourages the body to reabsorb water to maintain blood volume, so without enough ADH, the body will excrete more fluid, leading to a lower blood volume and increasing the risk of PH.

Check your medication.

24% of Canadians aged 20-79 are diagnosed with hypertension. In cases where the blood pressure is elevated, the logical treatment option is an attempt to lower the pressure. The actions of these medications such as ACE inhibitors, thiazide diuretics, and beta blockers may vary, but they all lower blood pressure moderately.

The risk in their use is based on the individual and interactions. For instance, some people may have a gene mutation that impacts the action of the drug and causes it to be too effective, leading to a massive drop in blood pressure. Other times, individuals may choose to use a more natural remedy such as liquorice root (Glycyrrhiza glabra) that has an additive effect with diuretic drugs, and may lead to a severe drop in blood pressure. Checking with your primary care provider is the safest way to avoid these interactions.

I’m looking for some solutions.

As mentioned, chronic constriction of the blood vessels is a sure way to prevent blood from getting where it needs to be in a timely fashion.

Herbs such as Gingko biloba contain active components known as terpenoids that encourage the dilation of blood vessels.

While this would be detrimental if we further decreased the blood pressure in the upper body, the terpenoids would help normalize the response of the baroreceptors and dilate the vessels in the lower body, encouraging the rapid return of blood around the body. Tinctures such as Gingko and tablets such as Ginkgo Extra are made from the leaves of the tree and provide the terpenoids necessary for its benefits.

Increasing the strength of the heart enables it to pump blood more effectively and efficiently. Exercise can help achieve this goal and does more than that!

Humans are amazing and evolved with a way to deal with the effects of gravity. Located in the blood vessels of our lower legs are one way valves that cause the blood to travel up the legs and back towards the heart. When the muscles of the lower limbs contract, they squeeze these vessels and encourage the blood to return – so increasing the strength of these muscles ensures a healthy circulation.

The signs and symptoms of PH, including dizziness, low blood pressure, and a feeling of heaviness, are similar to a number of conditions. In the end, it is always critical to seek the advice of your trusted healthcare practitioner to ensure you receive the appropriate treatment and advice.

References:
https://www.aafp.org/afp/2003/1215/p2393.html
https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831618/
https://www.ncbi.nlm.nih.gov/pubmed/10653831
https://www.ncbi.nlm.nih.gov/pubmed/11903307
https://www.ncbi.nlm.nih.gov/pubmed/12464140
https://www.ncbi.nlm.nih.gov/pubmed/14687903
https://www.ncbi.nlm.nih.gov/pubmed/17564952
https://www.ncbi.nlm.nih.gov/pubmed/23352231
https://www.ncbi.nlm.nih.gov/pubmed/26502571
http://www.statcan.gc.ca/pub/16-001-m/2009010/part-partie1-eng.htm
https://www.statcan.gc.ca/pub/82-625-x/2016001/article/14657-eng.htm

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