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Orthostatic hypertension is diagnosed by a rise in systolic BP of 20 mmHg or more when standing. Orthostatic diastolic hypertension is a condition in which the diastolic BP raises to 98 mmHg or over in response to standing, [ 2 ] [ 3 ] [ 4 ] but this definition currently lacks clear medical consensus, so is subject to change.
POTS patients experience an increase in heart rate within a few minutes of standing or sitting up. This makes it different from other conditions that generally cause a fast heart rate.
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Only continuous beat-to-beat BP measurement during an active standing-up maneuver can document this condition. [32] Classic orthostatic hypotension is frequently characterized by a systolic blood pressure decrease of ≥20 mmHg or diastolic blood pressure decrease of ≥10 mmHg between 30 seconds and 3 min of standing. [33]
The basic physiological change that occurs in the body during prolonged standing or sudden stand from supine position is that there will be increased pooling of blood in the legs. This decreases the venous return, and so there will be decreased cardiac output, which ultimately causes systolic blood pressure to fall (hypotension).
Cardiac output (CO) is affected by two factors, the heart rate (HR) and the stroke volume (SV), the volume of blood pumped from one ventricle of the heart with each beat (CO = HR × SV, therefore BP = HR × SV × TPR). In reflex bradycardia, blood pressure is reduced by decreasing cardiac output (CO) via a decrease in heart rate (HR). [citation ...
When blood pressure rises, the carotid and aortic sinuses are distended further, resulting in increased stretch and, therefore, a greater degree of activation of the baroreceptors. At normal resting blood pressures, many baroreceptors are actively reporting blood pressure information and the baroreflex is actively modulating autonomic activity.
Blood pressure varies over longer time periods (months to years) and this variability predicts adverse outcomes. [18] Blood pressure also changes in response to temperature, noise, emotional stress, consumption of food or liquid, dietary factors, physical activity, changes in posture (such as standing-up), drugs, and disease. [19]