Back
Orthostatic Hypotension
Definition
  • a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes after standing
  • However, persons with SCI can often become symptomatic even when sitting.
Risk Factors
  • injuries T6 and higher
  • complete injuries
Treatment
  • Reposition — decrease seat-back angle in a recliner wheelchair from near supine gradually to full upright as tolerated
  • Elastic stocking/abdominal binder/ace wrap LE
  • Exercises –use of tilt table
  • Fluid resuscitation: increase fluid intake
  • Pharmacological
    • salt tablets
    • midodrine: used 1 hour prior to desired effect
    • fludrocortisone
  • References

    Claydon VE, Steeves JD, Krassioukov A. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord 2006 Jun;44(6):341-351.

    Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011 Apr;21(2):69-72.

    Garstang SV WH. Spinal Cord Medicine. Kirshblum S. C, D, editor. 2nd ed.: LWW; 2011. Chapter 9, Cardiovascular and autonomic dysfunctions after spinal cord injury. p.136-154.

    Partida E, Mironets E, Hou S, Tom VJ. Cardiovascular dysfunction following spinal cord injury. Neural Regen Res 2016 Feb;11(2):189-194.