[en] Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences. [fr] : L’hypotension orthostatique (HO) se définit par
une chute de pression artérielle d’au moins 20 mmHg pour la
systolique et 10 mm Hg pour la diastolique lors du redressement. Les symptômes d’appel sont souvent évocateurs, mais
peuvent être également frustes. Le diagnostic peut se faire simplement au cabinet de consultation et peut être confirmé par
des mesures plus spécialisées, si nécessaire. La physiopathologie est généralement complexe, mais implique très souvent
une atteinte du système nerveux autonome, essentiellement
dans sa composante sympathique. Un déficit de vasoconstriction périphérique semble jouer un rôle plus important qu’un
déficit de la tachycardie réflexe. Les causes sont multiples.
L’HO peut survenir chez un sujet sain, dans des circonstances
exceptionnelles, mais est plus souvent associée à des pathologies diverses, neurologiques ou caractérisées par une hypovolémie. Différents médicaments peuvent aggraver le risque
d’HO, dont certains antihypertenseurs et psychotropes. La
personne âgée, particulièrement en cas de fragilité, est exposée
à un risque important d’HO, d’origine multifactorielle, avec
parfois des conséquences médicales graves.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
TYBERGHEIN, Maëlle ; Centre Hospitalier Universitaire de Liège - CHU > > Service de médecine de l'appareil locomoteur
PHILIPS, Jean-Christophe ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Krzesinski, Jean-Marie ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
SCHEEN, André ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Language :
French
Title :
L'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.
Alternative titles :
[en] Orthostatic hypotension: definition, symptoms, assessment and pathophysiology
Publication date :
2013
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Université de Liège. Revue Médicale de Liège, Liège, Belgium
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