MANAGEMENT OF ORTHOSTATIC (POSTURAL) HYPOTENSION (original) (raw)

Orthostatic (or postural) hypotension is defined as a sustained reduction of systolic blood pressure of at least 20 mmHg and/or diastolic blood pressure of at least 10 mmHg, or Systolic blood pressure fall >30 mmHg in hypertensive patients with supine systolic blood pressure > 160 mmHg, when assuming a standing position or during a head-up tilt test of at least 60°. Orthostatic Hypotension results from an inadequate physiological response to postural changes in blood pressure. In people with the condition, standing leads to an abnormally large drop in blood pressure, which can result in symptoms such as light-headedness, dizziness, blurring of vision, syncope and falls Orthostatic hypotension may be idiopathic or may arise as a result of disorders affecting the autonomic nervous system (for example, Parkinson's disease, multiple system atrophy or diabetic autonomic neuropathy), from a loss of blood volume or dehydration, or because of certain medications such as antihypertensive drugs Orthostatic hypotension is more common in older people, and estimates of prevalence range from 5% to 30% of people aged over 65 years (in the general population), up to 60% of people with Parkinson's disease, and up to 70% of people living in care homes. It is estimated that about 0.2% of people aged over 75 years are admitted to hospital with problems relating to orthostatic hypotension Referral Criteria  These guidelines are for patients over 18 years of age.  Shared Care is only appropriate if it provides the optimum solution for the patient.  Prescribing responsibility will only be transferred when it is agreed by the consultant and the patients' GP  Safe prescribing must be accompanied by effective monitoring  When transfer is agreed, the patient will be given a supply of medication sufficient for 4 week maintenance therapy  The doctor who prescribes the medication has the clinical responsibility for the drug and the consequences of its use. SHARED CARE RESPONSIBILITIES Consultant 1. Undertake the necessary testing to confirm a diagnosis of orthostatic hypotension 2. Ensure the patient's concurrent drug therapy is stabilised and there are no contra-indications to treatment options for orthostatic hypotension 3. Ensure that patient is aware of risks and benefits of medication and has read appropriate information leaflets 4. Ensure the patient understands the shared care agreement and has signed the Patient Agreement Letter (Page 12) 5. Perform baseline tests (see Monitoring section) and provide results to GP 6. Initiate treatment and prescribe until the GP formally agrees to share care (as a minimum, prescribe the first 3 months or until patient is stabilised). 7. Send a letter to the GP requesting shared care for this patient. 8. Review the patient in outpatients as clinically appropriate and advise the GP promptly after these reviews on when to adjust the dose, stop treatment or consult with the specialist. 9. Inform GP, by letter, of each clinic attendance and action taken for the management of the patient ensuring current dose, most recent blood results and frequency of monitoring are stated. 10. Evaluate any reported adverse effects by GP or patient. 11. Inform GP of patients who do not attend clinic appointments, admin to contact patient to rearrange. 12. Ensure that backup advice is available at all times. (see Contacts section) 13. To report any adverse events to the CHM and GP: https://yellowcard.mhra.gov.uk/