Postural Hypotension (Orthostatic Hypotension)

CLINICAL DIAGNOSTIC MANUAL

Postural hypotension, also known as orthostatic hypotension, is a condition where blood pressure drops significantly when a person stands up from a sitting or lying position. This drop in blood pressure can lead to symptoms such as dizziness, fainting, and blurred vision. Postural hypotension is a common issue, particularly in older adults, and can be caused by various factors, including medications, dehydration, neurological disorders, and cardiovascular diseases.

Pathology	Suspected Diagnosis	Confirmatory Diagnosis
Medication-induced	Hypotension temporarily associated with the start or change of medication.	Clinical history, medication review.
Autonomic neuropathy	Hypotension, autonomic dysfunction, history of diabetes or neurological disorders.	Autonomic function tests, blood tests, neurological studies.
Idiopathic orthostatic hypotension	Hypotension without identifiable cause, dizziness, syncope on standing.	Diagnosis of exclusion, tilt-table test.
Cardiogenic failure	Hypotension, dyspnoea, fatigue, peripheral oedema.	Echocardiogram, blood tests (BNP, troponins).
Low blood volume	Hypotension, tachycardia, pale and cool skin, oliguria.	Complete blood count, electrolytes, abdominal ultrasound, urine analysis.
Loss of vascular tone	Hypotension, tachycardia, signs of shock, warm and moist skin.	Clinical history, autonomic function tests, blood tests.
CNS disorders	Hypotension, neurological dysfunction, changes in mental status.	MRI or CT of the brain and spinal cord, neurological examination.
Other causes	Hypotension related to dehydration, hemorrhage, or severe infections.	Clinical history, blood tests, imaging as indicated by suspected cause.