Heart Health: 10 Essential Facts About Orthostatic Hypotension

orthostatic hypotension
By Mark Henricks, reviewed by Michael Cutler, DO, PhD
Published by EveryDayHealth.com
This article includes excerpts from interviews with Dr. Guy Mayeda.

That spinning feeling when you stand up probably means your blood pressure just dropped.

Maybe this has happened to you: You’re getting out of bed or rising from a chair and unexpectedly feel dizzy or lightheaded.

Your vision may dim or blur or you could have tunnel vision. To add to this already frightening experience, you may also feel confusion and dizziness. Less commonly, you could have dull pain across the back of your neck and shoulders. Rarely, you could lose consciousness or faint.

These are symptoms of a condition called orthostatic hypotension, which results when blood pressure drops excessively due to a change in position.

Who can have orthostatic hypotension? It is very common, especially among older people, affecting approximately 18 percent of those over 65, notes a 2011 review in American Family Physician. It becomes even more prevalent as people age, with up to half of elderly people living in institutions, such as nursing homes, meeting the definition for orthostatic hypotension, according to a 2013 position paper in Journal of Clinical Hypertension.

Does orthostatic hypotension go away? Typically, yes, an episode of hypotension ends quickly; once you sit or lie down, symptoms disappear. The biggest risk for most people who have orthostatic hypotension is injury from a fall. But if you have chronic or recurrent orthostatic hypotension, it may indicate a more serious underlying condition.

Here are 10 essential facts about orthostatic hypotension:

1. Most Episodes of Orthostatic Hypotension Go Unnoticed

2. Gravity Is the Basic Culprit
What causes orthostatic hypotension? When you’re lying down, your blood is evenly distributed throughout your body. When you stand up, gravity causes blood to pool in your legs. “Normally, blood vessels in the lower body constrict when we stand up — also known as vasoconstriction — to prevent the blood pressure from dropping too much as we change position,” explains Guy Mayeda, MD, a cardiologist at Good Samaritan Hospital in Los Angeles. If this compensation fails to occur rapidly enough or strongly enough, blood flow to your brain can decrease and become briefly starved of oxygen. The brain is extremely sensitive to low oxygen levels, and that leads to dizziness and other symptoms.

3. Orthostatic Hypotension Usually Resolves Quickly

4. Age Is One of the Biggest Risk Factors for Orthostatic Hypotension

5. Dehydration Is One of the Most Common Causes

6. Orthostatic Hypotension Particularly Affects Healthy Exercisers

7. You Should See Your Doctor if You Have an Episode
Although orthostatic hypotension is rarely harmful, consider making a doctor’s appointment if you experience it for the first time. “It should be taken seriously because studies have shown that people with orthostatic hypotension are at higher risk of developing cardiovascular problems in the future,” says Kristine Arthur, MD, an internist at Orange Coast Memorial Medical Center in Fountain Valley, California. There is a link between orthostatic hypotension and increased risk of congestive heart failure, Arthur adds. Orthostatic hypotension could also be a sign of other aliments, including diabetic neuropathy, thyroid problems, and Parkinson’s disease.

8. Diagnosis Is Quick, Simple, and Painless

9. A Variety of Treatments Work for Orthostatic Hypotension

10. Behavior Modification Is Often the Best Treatment
How can you prevent orthostatic hypotension? Simply pausing for a minute before rising from bed can significantly reduce episodes of orthostatic hypotension, because this allows your cardiovascular system to adjust. This is especially relevant when you’ve been sleeping and are getting up in the middle of the night. Here are other ways to reduce the number or risks of orthostatic hypotension episodes:

  • Keep one hand on a rail or support when rising.
  • Be ready to sit or lie back down quickly if symptoms begin.
  • Stay hydrated.
  • Take medications at bedtime.
  • Your doctor may also recommend wearing compression socks to reduce blood pooling in your legs.

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New Cholesterol Drug Called a Game Changer

lowercholesterol-healthierheart
Find Out If You’re a Candidate For New Cholesterol-Lowering Medication

By Gina Roberts-Grey, Special to Lifescript
Published July 27, 2015

A new class of drug that battles high cholesterol levels has won approval from the Food and Drug Administration. Read on to learn how the new drug, called a game changer, works and whether it’s right for you…

Patients whose high cholesterol is resistant to most treatments now have a new weapon in their medication arsenal.

The injectable prescription medication alirocumab won Food and Drug Administration (FDA) approval July 24. It’s the first in a new class of drugs aimed at lowering high cholesterol. Although it’s not yet approved for use in all patients, the medicine is creating a great deal of excitement in the medical world.

Who should take it?
Only patients with heterozygous familial hypercholesterolemia – a genetic condition in which you have high cholesterol levels, or have had a prior heart attack or stroke – should take the drug, according to the FDA release.

Not a statin
Typically, high cholesterol is treated with statins such as atorvastatin or simvistatin.

“These medications are effective in most patients, but are not potent enough to lower LDL [bad] cholesterol to target levels in extreme situations, including patients with heterozygous familial hypercholesterolemia,” says Guy Mayeda, M.D., a cardiologist at Good Samaritan Hospital in Los Angeles.

That’s where alirocumab come in.
“This new medication … provides a new alternative for patients with the highest risk of cardiovascular events from inadequately controlled high cholesterol,” Dr. Mayeda says.

Five studies involving nearly 2,500 patients were conducted to test the safety and efficacy of the drug. Alirocumab was found to lower LDL levels between 36% and 59%.

However, that better control comes with big price tag.

Expensive medication
“[Alirocumab] is significantly more expensive than traditional statin medications,” Dr. Mayeda says.

Regeneron, the makers of alirocumab, will sell the drug wholesale for $1,120 for two doses, which lasts 28 days. The annual cost of the drug could cost patients up to $14,560, depending on their health insurance coverage and co-pays.

The drug is not without risks, either.

Side effects
The FDA says the most common side effects include “itching, swelling, pain, or bruising where the injection is given, nasopharyngitis [inflammation of the mucus membranes] and flu.”

Allergic reactions, including vasculitis (a skin rash that appears as purple-colored spots on the skin and is associated with inflammation of the small blood vessels) and hypersensitivity reactions requiring hospitalization have been reported with the use of the drug.

“As with all newly approved medications, patients and their physicians should be diligent in watching for potential side effects,” Dr. Mayeda cautions.

Not a magic bullet
While alirocumab may hold promise, experts caution it’s not a cure-all for high cholesterol.

“[Alirocumab] is a supplemental therapy to diet and statin therapy,” says Robert Greenfield, M.D., a cardiologist, lipidologist and chief of staff at Orange Coast Memorial Medical Center in Fountain Valley, CA.

”This is not meant to replace statins, as statins have decades of outcome data proving that they save lives by reducing heart attack and stroke rates.”

Although positive safety data were presented to the FDA, additional data that will come after many more patients use the medication may reveal “additional adverse side effects,” Dr. Greenfield says.

The next phase of trials will help doctors and their patients know if the drug is as promising as the initial results seem to indicate.
Lifescript
interview with Dr. Guy Mayeda

Why exercise is important— even if you don’t need to lose weight

exercise important for more than just losing weight

 

Fox News interview with Dr. Mayeda:

The promise of a smaller waistline may get you into the gym, but all of your sweating and panting is delivering far more than aesthetic changes. An active lifestyle isn’t all about weight loss. Regular exercise can help prevent some of the most common diseases of the day, including heart disease, diabetes and certain types of cancer.

One in four deaths in the United States are due to heart disease, according to the Centers for Disease Control and Prevention (CDC), and more than 9 percent of the population lives with diabetes. Both of these conditions are largely preventable through proper diet and exercise, and their risks are tied to obesity. But some research suggests weight loss shouldn’t be the primary goal of a disease prevention lifestyle.

Shifting the focus from weight loss

“Recent articles that say exercise is ‘not worthwhile’ in regards to weight loss promote a dangerous misconception,” says Dr. Guy Mayeda, a cardiologist at Good Samaritan Hospital in Los Angeles.

A June editorial in the British Journal of Sports Medicine “busted the myth” of exercise being a catalyst for dropping pounds, saying “physical activity does not promote weight loss.”

But that conclusion is only part of the story. Although weight loss and management motivate many Americans to find time for exercise, those walkers, yogis and cyclists reap many additional benefits regardless of weight.

Mayeda adds that “while exercise alone will not guarantee weight loss in the presence of unlimited calorie intake,” it remains important in reducing various health risks and providing an overall sense of well-being.

Building a stronger heart and lungs

Obesity is a known risk factor for cardiovascular disease, but it isn’t the only one, and your bathroom scale can’t read the others.

“Exercise is the best medicine for the heart, and (the risks of) a sedentary lifestyle are equivalent to smoking one pack of cigarettes per day,” explains Dr. Robert Greenfield, medical director of non-invasive cardiology and cardiac rehabilitation at MemorialCare Heart & Vascular Institute in Fountain Valley, Calif.

Regular exercise increases the efficiency and health of your heart and lungs. It can also decrease your waist circumference— a known risk factor for heart disease— and instantly reduce your blood pressure, independent of weight.

Cancer risk reduction

Increasing your activity levels can reduce your risk of colon cancer by 30 to 40 percent, according to the National Cancer Institute, and the more active you are, the greater your risk reduction, regardless of your weight. Exercise drives similar dramatic reductions in the risk of breast cancer, and researchers around the world have repeatedly linked physical activity to reduced risks of uterine, lung and prostate cancers.

Improved digestive health

Exercise also regulates digestion, stimulating the muscles throughout your stomach and intestines, preventing constipation. It’s believed this stimulation could be tied to the reduced risk of colon cancer in active people.

Diabetes prevention and management

Type 2 diabetes is most commonly thought of as an obesity-related disease, and there’s no doubt that being overweight or obese puts you at a greater risk of getting it. But exercise can help even when your weight remains static.

According to the American Journal of Clinical Nutrition, waist circumference is the best determinant for diabetes risk than BMI or weight, meaning a lifestyle that reduces your stomach size can reduce your diabetes risk no matter your weight. Also, exercise increases insulin sensitivity and reduces blood sugar levels, again, regardless of what the scale says.

A sharper, happier brain

The benefits of exercise aren’t merely physical. Research has repeatedly shown that exercise reduces stress, improves mood, decreases the risks of anxiety and depression, and even boosts memory and cognition.

“All studies have shown that people who exercise suffer from less stress, are better with anger management, have healthier interpersonal relationships on average, sleep better and even think more clearly,” says Dr. Brian Quebbemann, bariatric surgeon and president of The N.E.W. Program bariatric clinics in Newport Beach, Calif. “In fact, contrary to the popular myth of the ‘dumb jock’, scientific data has shown that athletes, on average, perform higher on IQ tests than people who are sedentary.”

In short: Stay active.

Whether you’re happy with your weight or need to drop a few pounds, exercise has beneficial effects that surpass the number on your scale. Research published in the journal The Physician and Sports Medicine even suggests that approaching lifestyle disease risks, like heart disease, from a “non-weight loss centered paradigm” could be more beneficial than merely focusing on dropping pounds, even in overweight and obese people.

What does this mean for you? In addition to a healthy diet, staying active is crucial for overall health, and your body weight is just one factor in the complex equation.