Q: I am an 86-year-old man who was told I have postural hypotension, but I don't understand what it is. I wear high-compression support hosiery and have increased my salt intake.
I was taking Florinef to increase my blood pressure, but the doctor stopped it recently when my systolic blood pressure got too high, even though my diastolic blood pressure was still low, running between 45 and 80. What should I do?
-- L.H., Dallas
A: Postural hypotension is a condition in which a person's blood pressure does not respond fast enough when they get up suddenly. As a result, too little blood gets to the brain and the person feels dizzy and may feel close to passing out. Orthostatic hypotension is another name for this condition.
When we lie down or stoop over, less blood pressure is required to get blood to the brain. When we stand up, the blood pressure needs to rise to get enough there. Although the blood pressure actually falls in some people when they get up suddenly, in some it simply doesn't rise fast enough.
This occurs more and more as we age. In some it becomes a serious problem, causing the person to pass out (syncope). The resulting falls may cause injuries. It is particularly dangerous in someone your age, because your bones are probably weaker and the risk of fracture is higher.
The risk of developing postural hypotension increases somewhat in someone, like you, who already has a low diastolic blood pressure. Fortunately, your low blood pressure will help prevent heart disease and strokes in the future.
Blood pressure is regulated by how strong and how hard the heart pumps, as well as by the size of blood vessels. When either of these doesn't change fast enough, you may feel dizzy when standing up.
In most cases, nothing is found wrong with the heart. But it's still important to look, especially for someone who has another indication that the heart may not be normal. For example, a diastolic blood pressure of 45 is quite unusual in an 86-year-old person.
Postural hypotension is typically diagnosed based on the symptoms you tell your doctor, but it can be confirmed by doing a tilt test. In this test you lie down and are strapped to a table. The table is then suddenly tilted vertically while your heart rate, blood pressure, and the electrical activity of the heart are monitored.
Although this test may not find additional information that is helpful in guiding treatment, at least it will confirm that you have postural hypotension. If no problems are found with the heart, treatment consists primarily of removing potential causes and trying to increase blood pressure directly with increased sodium, hosiery and drugs such as Florinef.
Since your treatment does not seem to have helped, I suggest you speak with a cardiologist to discuss potential causes. These include: heart conditions, neurological problems (neuropathies and dysautonomia), medications such as tricyclic drugs and MAO inhibitors used to treat depression, and endocrine diseases such as pheochromocytoma.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.