What is Orthostatic Hypotension?
Orthostatic hypotension is a disorder that involves dysfunction of the autonomic nervous system (1). It is defined as a decrease in systolic blood pressure of 20 mmHg or a decrease in diastolic blood pressure of 10 mmHg within 3 minutes of changing positions from seated to standing. Systolic blood pressure measures pressure in the arteries when the heart beats and fills the arteries with blood. Diastolic blood pressure measures pressure when the heart is at rest, or between beats (3). In orthostatic hypotension, the failure of the autonomic nervous system, or ANS, to properly compensate for shifts in position by sending enough blood to the head can lead to dizziness, light-headedness, or even fainting episodes known as syncope. It may be acute or chronic and may present with or without other simultaneous symptoms.
How Common is Orthostatic Hypotension?
Orthostatic hypotension is a very common condition. It is most common in the elderly, postpartum mothers, those who have been on bed rest and teenagers experiencing growth spurts over short periods of time. It may affect anyone at any age, but is more prevalent as people age (16).
What Causes Orthostatic Hypotension?
Orthostatic hypotension is caused as a result of the body's diminished ability to regulate proper blood volume through the body, through the changing of positions. What causes this lack of regulation is different in each case, and some people have multiple contributing factors. It may be due to dehydration, anemia, blood loss, or disorders of the neurologic, cardiovascular or endocrine (hormonal) systems. It may also be a side effect of medication.
Regulation of the ANS involves several brain regions, including the cortical, subcortical and brainstem regions. Specific cortical regions, including the insular and medial prefrontal cortex, the amygdala, hypothalamus and brainstem regions have all been recognized as being important to the control of the autonomic nervous system (1). We also utilize the vestibular system in our inner ear to inform our brain of our head’s position relative to our body.
This information travels to our brainstem where it needs to integrate with information from our cortex about where we are in space in order to signal to our blood vessels that they need to constrict and send blood to our brain (4). Dysfunction in one or multiple systems involved in this complex orchestration can lead to orthostatic hypotension.
What are Symptoms of Orthostatic Hypotension?
Symptoms of orthostatic hypotension differ from person to person. They may include any of the following constellation of symptoms:
severe and long-lasting fatigue
lightheadedness or dizziness when changing posture
fainting
nausea
headaches
brain-fog” (thought and focus difficulties)
increased muscle tone in the neck and shoulders
chest pain
a sensation of powerful or irregular heartbeats
blurred vision
pale face/discolored hands and feet.
Not all patients will have all symptoms, and not all symptoms listed are the only symptoms of orthostatic hypotension (1).
What Happens in the Nervous System with Orthostatic Hypotension?
When someone goes from lying to standing, gravity pulls blood down towards their feet. The autonomic system needs to tell blood vessels to constrict, so that blood can be pumped back up to the brain. These reflexes work poorly in orthostatic hypotension, and blood flow to the brain subsequently decreases (18).
The brain will normally increase the heart rate to compensate for a drop in blood pressure. Sometimes the increase in heart rate is extreme, and thus the heart will beat before it has a chance to properly fill with blood. This leads to even less blood flow to the brain. These patients will suffer dizziness, often will faint, and frequently are injured as a result of falling. The literature also demonstrates that extremely high compensatory blood pressure and demand on the sympathetic nervous system can cause damage to the organs that process blood, such as the heart and kidneys (2).
When the brain does not receive sufficient blood flow, myriad symptoms may present. Your brain requires a great deal of energy to function properly, and when this is disrupted, a host of brain functions are disrupted. Simple cognitive tasks become profound challenges, simple physical tasks become exhausting. Emotional regulation can become extremely difficult. Everything your brain does depends on the ability to properly regulate blood flow. When this fails, virtually everything your brain attempts to do can become a struggle (3).
How is Orthostatic Hypotension Usually Treated?
There is no known established cure for orthostatic hypotension. Most cases are treated through lifestyle changes, diet, and physical exercise (8,9). For some patients, medications are used that act on the kidneys, causing them to retain salt and thus increase blood volume. While these can help mitigate some of the symptoms of orthostatic hypotension, they generally do little to affect the impaired autonomic reflexes that are the underlying cause of the disorder (17).
How is the NeuroRescue Program Different?
One of the main things your brain does, and maybe even the primary thing, is help you determine where you are in the world. Your brain uses inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses inputs from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is in relation to the visual environment.
Your brain needs to put all of that together to make sense of where the world is, and where you are in relation to the world. It needs to be able to localize you effectively in the environment, in order for you to be able to respond to the environment properly.
Your brain organizes all of this information in terms of maps. There is a vestibular map from the inner ear, a proprioceptive map from muscles and joints, a vascular map of your blood flow, a visual map of the world from your eyes, and several others. Your brain needs these maps to be saying largely the same thing about where you are in the world at all times.
One often overlooked feature of orthostatic hypotension is that these maps usually fail to match. Your eyes, inner ear, and muscles are creating maps that say different things about where your head is in relation to gravity. When you go from lying down to sitting up or standing, problems in these maps can make it difficult for the brain to compensate for the postural shift. If the brain does not understand the position of the head in relation to gravity, it cannot properly control the vascular system to send the appropriate amount of blood to the head (3). We utilize eye movements to activate the various cortical, subcortical and brainstem regions involved in the ANS to improve function and connectivity (10).
This is why many patients fail to fully resolve their orthostatic hypotension with most forms of treatment. Without addressing the problems in these maps, it will remain impossible for the brain to properly control blood flow, and the best they can hope for is to gain some control over their symptoms. We would much rather try to address the underlying cause. Our therapies are target towards first restoring appropriate visual, vestibular, and proprioceptive maps. Once these are working well individually, we retrain your system against different gravitational vectors so you can begin to control your autonomic system properly again. This approach gives us our best hope to resolve your hypotension so you can get back to living the life you deserve.
How does the NeuroRescue Program work?
We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.
We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.
Our examination allows us to identify the areas and pathways of your brain that have been impacted by your injury. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.
We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.
We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.
We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We also perform a passive tilt table test (7). We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.
We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.
We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.
Our therapies may range from specific eye exercises (11), to specific types of vestibular therapy (12), to unique forms of electrical stimulation (13). We may employ laser and LED photobiomodulation (14), or even exercises in a virtual reality environment (15). All of our therapies will be specific to your unique case, based purely on your neurodiagnostic testing data and examination findings.
We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.
While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. We find this approach to be very effective in treating orthostatic hypotension and other forms of autonomic nervous system dysregulation. This gives us our best opportunity to get your orthostatic hypotension under control, and return you to living a healthy, vibrant, and fulfilling life. And while no one can ever guarantee results, we have been helping improve autonomic function and, in many cases, resolving symptoms of orthostatic hypotension and similar disorders for decades.
Your Next Best Step:
To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day. And remember, it’s never too late to start getting better.
