Orthostatic hypotension: pathophysiology, problems, and prevention

Orthostatic hypotension (OH) has traditionally been associated with falls (). However, data has been inconsistent, and some believe that more research in the area is needed before a true link can be made (A. ). OH, a drop in systolic pressure of ≥ 20 points or in diastolic pressure of ≥ 10 points within 3 minutes of standing as compared to the reading while supine may be accompanied by tachycardia, syncope, dizziness, visual changes, and death. Pathophysiological causes of OH include the dependent pooling of blood in organs and the periphery, compromised venous return and stroke volume, and changes in cardiac and baroreceptor function. Hypertension, diet, mobility, and medications may also contribute to the disorder. The treatment goal is to educate the patient, eliminate physiological causes, omit contributing medications, and resort to pharmacologic means as needed (). Thorough knowledge about OH can assist home care nurses in assessing for and educating patients about the disorder. This manuscript will discuss the pathophysiology, contributing diagnoses and drug classes, signs and symptoms, treatment, and implications for home care and hospice nurses related to orthostatic hypotension.