Orthostatic Hypotension
Dr. Leonel Porta
Written by Dr. Leonel Porta

While it is true that high blood pressure is the most important risk factor for cardiovascular morbidity and mortality, it should be pointed out that the pressure exerted by blood on veins and arteries may fall below their normal levels, indicating that something is wrong.

Diabetics who suffer from Autonomic Neuropathy may have a particular type of low blood pressure called Orthostatic Hypotension (OH). Today we will explain what OH is, why it occurs and what can we do about it.

Orthostatic Hypotension is a drop in arterial blood pressure that occurs after a   person has been standing for a long time, or when standing up after sitting or lying down. Have you ever experienced some dizziness when standing up very quickly after being in a lying position for a while? If your answer is yes you have been the victim of postural hypotension, medically known as Orthostatic Hypotension.

This disorder is caused by the lack of strength in pumping blood by the heart, so that the supply of oxygen and nutrients to the brain is insufficient to maintain the brain’s normal activity.

Under normal conditions when a person sits or stands up, gravity causes the blood to be drawn to the lower part of our body. To compensate for that drop our heart beats faster, stronger, and arteries constrict to generate more pressure as blood flows. When these mechanisms fail, Orthostatic Hypotension occurs.

The symptoms experienced during hypotension include dizziness, blurred vision, fainting and, in severe cases, seizures.   In most cases it is a temporary feeling, but in the case of diabetes it is a chronic problem because the constant increase in blood glucose levels causes atrophy of the nerves which control blood pressure.

The doctor can make a diagnosis based on the symptoms presented by the patient and by checking the blood pressure several times before and after changing positions. However, the most important thing is to determine the cause of orthostatic hypotension, for which blood tests, urinalysis, chest/spine X-rays may be required. Orthostatic Hypotension can be caused by dehydration, malnutrition, aging, alcohol abuse, some neurodegenerative and heart diseases, spinal cord injury, and consumption of certain drugs.

Here are some overall guidelines for treating Orthostatic Hypotension:

  • Do not sit or stand up too quickly or remain standing for too long without moving.
  • Wear elastic compression socks and perform physical activities that help blood circulation in the legs.
  • Avoid long sessions under the sun as well as intense strain. This is especially recommended for the elderly because of their increased risk factors.
  • Keep a well balanced diet with plenty of fruits, vegetables, bran, fish, and white meats, reducing the consumption of fat, sugar and refined flour.
  • If the patient does not suffer from heart diseases (hypertension or cardiac insufficiency), salt can be added to the diet which helps as it helps retain more fluids in blood.
  • Drink plenty of fluids, reduce or eliminate alcohol consumption, and follow your medical treatment for controlling your glycemia.

Diabetic Cardiovascular Neuropathy is not restricted exclusively to Orthostatic   Hypotension since tachycardia can also cause heart failure at rest. This problem is resolved favorably in most cases, but in diabetics the prognosis is guarded. Therefore, strict medical supervision and an early diagnosis of diabetes and its complications are the only medical resources we have to guarantee our future well being.


About the author

Dr. Leonel Porta

Dr. Leonel Porta

Medical doctor and author of several publications. He has developed experience as a general practitioner and occupational health care, continually facing diabetes. His medical training and Jesuit values enable Leonel’s articles to seek not only physical, but also psychological, social and spiritual healing.