Understanding Orthostatic Hypotension: Causes, Symptoms, and Treatment Strategies

Orthostatic Hypotension - Dizzy when you stand up

Dizziness when you stand (orthostatic hypotension) can occur due to cortisol and salt imbalances … as well as a problem in your neck. Clear Chiropractic is an upper cervical specialist practice in Spokane, Washington that is a natural choice in healthcare without twisting, stretching or cracking.

Orthostatic hypotension (OH) is a condition characterized by a sudden drop in blood pressure when an individual stands up quickly. This drop can lead to dizziness, lightheadedness, or even fainting. The physiological mechanism that typically causes an increase in blood pressure upon standing fails in individuals with OH, resulting in these symptoms. Despite its common occurrence, many people remain unaware of its causes and potential treatments.

Differentiating Orthostatic Hypotension and Orthostatic Intolerance

While orthostatic hypotension and orthostatic intolerance (OI) are often discussed interchangeably, they are distinct conditions. Orthostatic intolerance refers to difficulty in maintaining a stable blood pressure upon standing, but the body eventually compensates. Orthostatic hypotension, however, involves a sustained drop in blood pressure after standing for a few minutes. The same is true of positional orthostatic tachycardia syndrome (POTS). Although the hallmark symptom – dizziness upon standing – is the same, the key point of differentiating in POTS is that the heartbeat begins to race (>100 bpm). This increased heartbeat does not occur with either OH or OI. Understanding these differences is crucial for accurate diagnosis and treatment.


Causes and Risk Factors

Several factors contribute to both orthostatic hypotension and orthostatic intolerance. Chronic stress and decreased cortisol levels are significant contributors. Cortisol, the body’s primary stress hormone, plays a critical role in regulating blood pressure. Continuous stress can deplete cortisol levels, impairing the body’s ability to adjust blood pressure appropriately.

The adrenal glands, which produce cortisol, also regulate blood sugar and electrolyte balance. Overloading these glands with stress, excessive sugar intake, insufficient salt, or certain medications can lead to chronic fatigue. When the adrenal glands are overworked, the body relies on the locus ceruleus in the brain to produce norepinephrine. If this pathway is also fatigued, the body struggles to maintain blood pressure upon standing, leading to dizziness and imbalance.

Managing Stress and Lifestyle Changes

Addressing chronic stress is vital for managing orthostatic hypotension. While reducing stress might seem straightforward, it can be challenging due to the demands of modern life. Nonetheless, incorporating stress-reduction techniques such as mindfulness, meditation, and regular exercise can be beneficial. Ensuring adequate rest and considering stress management strategies are essential steps toward alleviating the symptoms of orthostatic hypotension.

Importance of Electrolyte Balance

Sodium, a key electrolyte, is often misunderstood due to its association with high-sodium diets and cardiovascular issues. However, maintaining proper sodium levels is crucial for blood pressure regulation. An imbalance in electrolytes like sodium, potassium, chloride, calcium, or magnesium can disrupt the body’s overall function.

Sweating, whether from heat or indoor heating, leads to the loss of water and salt. Thus, individuals experiencing orthostatic intolerance or hypotension should ensure they consume enough salt. Drinking water alone is insufficient; without proper electrolyte levels, the body cannot retain water effectively. Avoiding diuretics like caffeine is also recommended to give the adrenal glands a chance to recover and maintain electrolyte balance.

Dietary Considerations

A diet high in sugar can exacerbate orthostatic hypotension by causing chronic inflammation and straining the adrenal glands. Reducing sugar intake and increasing protein consumption can help stabilize blood sugar levels and support adrenal function. Avoiding refined carbohydrates such as bread, pasta, and rice is also beneficial.

Dysautonomia and Mechanical Factors

Dysautonomia, a dysfunction of the autonomic nervous system, can also cause orthostatic hypotension. The glossopharyngeal nerve, which monitors blood pressure, and the vagus nerve, which regulates several bodily functions, are closely related. Mechanical irritation of these nerves, often due to issues in the cervical spine, can lead to blood pressure irregularities, headaches, neck and jaw pain, and even fainting spells (e.g., vasovagal syncope).

Dysautonomia falls under functional neurological disorders, which do not typically appear in standard blood tests or MRI scans. Diagnosing and treating these disorders requires a combination of tests and clinical observations.

Comprehensive Healthcare Approach

Effectively managing orthostatic hypotension often requires a multi-disciplinary approach:

  1. Primary Care Physician: Consult your primary care physician to review medications, as some can lower blood pressure or cause electrolyte imbalances. Discussing symptoms and medication side effects is crucial for accurate diagnosis and treatment.
  2. Naturopathic Doctor: Naturopathic doctors can identify dietary, hormonal, and chemical imbalances that contribute to orthostatic hypotension. Comprehensive blood tests and personalized treatment plans can address underlying causes.
  3. Upper Cervical Chiropractor: This specialized branch of chiropractic care focuses on mechanical issues in the neck that may affect nervous system function. Upper cervical chiropractors use precise diagnostic tests to identify and correct these issues, potentially alleviating symptoms of dizziness and imbalance.

Orthostatic hypotension is a complex condition with multiple contributing factors, including stress, diet, electrolyte imbalance, and nervous system dysfunction. Addressing these factors through a holistic approach involving stress management, dietary adjustments, and consultations with healthcare professionals can significantly improve symptoms and quality of life. While there is no one-size-fits-all solution, understanding and addressing the underlying causes can lead to effective management and relief from the debilitating effects of orthostatic hypotension.

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