Lightheadedness Upon Standing Could Signal Heart Risk

MONDAY, March 19 (HealthDay News) — If your blood pressure drops
suddenly when you stand up, leaving you feeling lightheaded or woozy, you
may be at greater risk for developing heart failure, a new study
suggests.

This condition is known as orthostatic hypotension. According to the
study, people with orthostatic hypotension were 54 percent more likely to
develop heart failure than their counterparts who did not develop low
blood pressure upon standing. This risk was reduced to 34 percent when the
researchers teased out those who also had high blood pressure.

“Multiple risk factors can increase a person’s risk for developing
heart failure, including high blood pressure, coronary heart disease and
diabetes,” explained study author Dr. Christine DeLong Jones, a preventive
medicine resident at the University of North Carolina at Chapel Hill.
“Orthostatic hypotension may also increase this risk.”

Heart failure occurs when the heart can no longer pump strongly enough
for blood to the reach the rest of the body. About 5.7 million people in
the United States have heart failure, and about 300,000 people die from it
each year, according to the U.S. National Heart, Lung and Blood
Institute.

Exactly how orthostatic hypotension could lead to heart failure is not
fully understood. “We speculate that orthostatic hypotension and high
blood pressure may contribute to the risk of heart failure through a
similar pathway, such as through high blood pressure that happens
primarily when a person is laying down,” she added.

For the new study, researchers looked at more than 12,000 people
between the ages of 45 and 64 from four U.S. counties. Close to 11 percent
of people who developed heart failure during about 17.5 years of follow-up
had orthostatic hypotension at the start of the study, compared with only
4 percent of those who did not go on to develop heart failure. This link
was most pronounced among people aged 45 to 55, according to the findings,
published March 19 in Hypertension.

To test for orthostatic hypotension, your doctor will measure your
blood pressure while lying down and shortly after standing up. Orthostatic
hypotension is defined as a drop of 20 mm Hg or more in systolic (the top
number) blood pressure or a decrease of 10 mm Hg or more in diastolic
(bottom number) blood pressure upon standing.

Some people with orthostatic hypotension might not have symptoms and
may not require treatment. Others may experience dizziness, and others may
even pass out, Jones said. “If one passes out or has severe dizziness,
they should see a provider urgently.”

People with orthostatic hypotension who also have high blood pressure
should take steps to control blood pressure, and make sure their heart is
healthy, she said.

The study authors speculated that orthostatic hypotension might be an
indicator of early atherosclerosis — a buildup of plaque in the
arteries — brought on by high blood pressure.

However, the study does not show that orthostatic hypotension causes
heart failure, merely an association between the two.

Dr. Robert Myerburg, a professor of cardiology at the University of
Miami Miller School of Medicine, said it is way too premature to say that
orthostatic hypotension is a risk factor for heart failure based on this
study.

“Orthostatic hypotension can cause unpleasant symptoms and if they lead
to loss of consciousness or near loss of consciousness, it can lead to
accidents, but this is not something that will lead to cardiac arrest,” he
said. His advice is to drink plenty of fluid if you have low blood
pressure upon standing. “If it doesn’t bother you or cause any significant
symptoms, you don’t have to treat it,” he said.

Dr. Stephen Green, chief of cardiology at North Shore University
Hospital in Manhasset, N.Y., agreed. “If you get lightheaded, see your
doctor and they should see if you have orthostatic blood pressure, which
is a common source of lightheadedness or dizziness when you change
positions,” he said.

“It doesn’t mean you will die of heart failure if you have it, but over
time, we can keep an eye on any signs or symptoms for heart failure,”
Green added.

Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York
City, said that anything that helps diagnose heart failure earlier could
be beneficial. “This is an interesting paper, and if orthostatic
hypotension proves to be a cause or leads to heart failure in future
studies, we could possible identify heart failure earlier than we can
now.”

More information

Learn more about heart failure and how to treat it at the U.S. National Institutes of Health.

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