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Orthostatic Hypotension And General Principles In Antihypertensive Therapy

Updated on January 16, 2014

Neutrally Mediated Hypotension

Dehydration, blood loss, fever, severe anemia, convalescence from debilitating illnesses, prolonged bed rest and starvation all can cause hypotension
Dehydration, blood loss, fever, severe anemia, convalescence from debilitating illnesses, prolonged bed rest and starvation all can cause hypotension | Source

Orthostatic Hypotension

Sudden fall of blood pressure may occur on adopting the erect posture leading to symptoms such as giddiness and syncope. Generally, this is the result of other underlying diseases.

Causes are as follows:

  1. Polyneuropathy in diabetes, beriberi and amyloidosis;
  2. Autonomic neuropathy in syringomyelia, tabes dorsalis and subacute combined degeneration;
  3. Following surgical or medical sympathectomy;
  4. Adverse reaction to drugs, especially antihypertensive drugs;
  5. Idiopathic autonomic neuropathy (Shy Drager syndrome) and
  6. Dehydration, blood loss, fever, severe anemia, convalescence from debilitating illnesses, prolonged bed rest and starvation.

Avoid Hypotension As A Hypertensive

Optimum benefit is obtained only if the blood pressure is maintained at the desired levels throughout the day and night, continuously.
Optimum benefit is obtained only if the blood pressure is maintained at the desired levels throughout the day and night, continuously. | Source

General Principles Of Hypertensive Therapy

Optimum benefit is obtained only if the blood pressure is maintained at the desired levels throughout the day and night, continuously. Proper adjustment of dosage, frequent consultations and counseling to ensure drug compliance are all important to ensure success. Since adverse side effects may lead to loss of morale and discontinuation of therapy, all patients should be fully informed of the side effects.

Failure to comply with therapy is the most frequent cause for failure of control of hypertension. Abrupt withdrawal of therapy may lead to rebound rise of blood pressure and hypertensive complications such as hypertensive encephalopathy or cerebrovascular accidents. Once established, essential hypertension tends to persist and, therefore, lifelong therapy may be required in most cases but it may be possible to reduce the dose in many.

Treatment of hypertensive emergencies: These emergencies include hypertensive encephalopathy and acute left ventricular failure. General treatment consists of hospitalization, sedation with diazepam (10mg given intramuscularly), control of convulsion and treatment of acute pulmonary edema. The blood pressure can be lowered by giving any of the antihypertensive drugs, the most useful being sodium nitroprusside. After controlling the emergency, oral drugs are started and the patient is maintained on the optimum dose. Follow the table below.

Drugs
Oral Dose
Parenteral Dose
Reserpine
0.1-0.25mg thrice a day
0.5- 1mg intramuscularly
Methyl Dopa
250- 500mg 3 to 4 times daily
250- 500mg; i/m or i/v
Clonidine
0.1- 1mg daily
-
Propanolol
160- 320 mg/day
20-40mg; i/v
Hydralazine
40- 200 mg/day
5- 20mg i/v or i/m
Sodium Nitroprusside
-
1-8mcg/kg/mt. i/v drip
Diazoxide
-
150-300mg i/v bolus
Minosidil
20-40 mg/day
150-300mg i/v bolus
Prazosin
10-20mg/day
150-300mg i/v bolus
Captopril
150- 400mg/day
150-300mg i/v bolus
Nifedipine
10- 20 mg thrice daily
150-300mg i/v bolus

© 2014 Funom Theophilus Makama

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