Hypertension and prevention of orthostatic hypotension

By adhering to the "three-step slow-motion walk" when changing daily postures, taking antihypertensive drugs as directed by your doctor to avoid overdose, regularly monitoring the blood pressure difference between lying and standing positions, and avoiding triggers such as high fever, holding back urine, and squatting for a long time, you can keep more than 90% of the risk of disease at bay.

It sounds simple, but there are many patients with high blood pressure who are really troubled by this problem. I just removed the sutures on the forehead of 72-year-old Chen last week. He woke up too early in the morning and sat up from the bed without being able to stand firmly. He knocked his head on the bedside table and received four stitches. Afterwards, he measured his lying and standing position. The blood pressure difference was a full 32mmHg, which is a typical orthostatic hypotension attack - that is, the systolic blood pressure dropped by more than 20mmHg and the diastolic blood pressure dropped by more than 10mmHg within 3 minutes of standing, dizziness and blackheading caused by short-term insufficient blood supply to the brain, and severe direct syncope and fall.

Regarding the reason why patients with hypertension are more likely to suffer from orthostatic hypotension, there have always been two different views in the academic community: One group believes that most of them are induced by drugs, especially α-blockers, high-dose diuretics, and some tricyclic antidepressants, which will expand blood vessels or reduce blood volume. When you stand up suddenly, the blood cannot return to the brain in time, making you prone to fainting.； Another school of thought believes that long-term hypertension itself will damage the autonomic nervous system, making blood vessel walls less elastic and slowing down reaction speed. Even without medication, postural blood pressure fluctuations are more likely to occur in healthy people than in healthy people. The two factors are often superimposed and difficult to completely separate.

Many patients I have interacted with did not take "slow motion" seriously at first. They thought that they were usually tough and squatting down and standing up was nothing. They didn't remember it until they fainted once. Retired teacher Wang always forgot before, but later he invented the "3-second rule". Whether he is getting up from the bed, getting up from the sofa, or standing up after squatting on the toilet, he should first stop for 3 seconds to move his legs and feet, then slowly use the weight next to him to get up, stand still and wait for 3 seconds before taking a step. In the past two years, he has never fainted again. Don't underestimate the pause of these few seconds. It gives the blood vessels enough time to react, which is more effective than any tonic.

As for the adjustment of antihypertensive drugs, there is currently no unified standard answer in clinical practice. Some doctors believe that for patients with orthostatic hypotension, it is enough to control the systolic blood pressure between 130 and 140mmHg. There is no need to force the blood pressure to fall below 120mmHg to avoid low blood pressure inducing syncope.； Some scholars have also suggested that as long as there are no frequent episodes of dizziness and blackness, one should still try to lower blood pressure to the standard recommended by the guidelines, as long as one pays attention to the rhythm of movements every day. You don’t have to worry about this. Every time you have a follow-up visit, tell the doctor whether you feel dizzy when you stand up. Let the doctor adjust the medicine based on your specific situation. Don’t increase or decrease the medicine casually. I have seen too many examples of people who took half an extra antihypertensive medicine and ended up fainting in the emergency room.

There are also some small pits that are easy to step on. You should pay more attention to them. Don’t take too long hot baths in summer. It is easy to get dizzy when your blood vessels expand and stand up suddenly.； Don’t hold your urine for too long, especially when you wake up in the morning. Many people rush to run after holding their urine. Rapid emptying of the bladder can also cause a drop in blood pressure. ； It's not enough to squat and work under the sun for a long time. When the weather is hot, blood vessels will expand, and when you stand up suddenly, your blood supply will not be able to keep up. Last summer, I treated an old man who squatted in the vegetable field for half an hour to pull weeds. He stood up and fell directly into the vegetable patch. Fortunately, he was not seriously injured because he was growing lettuce. It would have been troublesome if there were rocks nearby.

In fact, to put it bluntly, this problem is that our blood vessels are "slow to respond." We just need to follow the reaction slowly, don't be too nervous, and don't take it seriously. You can usually measure your lying down and standing blood pressure by yourself at home. Measure it once while lying down, and then measure it again after standing up for 3 minutes. If the difference is more than 20mmHg, you should eat more snacks, slow down and be steady, which is better than anything else. If you suddenly feel dizzy when you stand up, don't force yourself to walk forward. Hold on to the wall or furniture next to you. If you can't, just squat down or even sit on the ground. Just take a few minutes to relax. It's much more cost-effective than breaking bones or hitting your head.