From the Guidelines
Positive orthostatics, also known as orthostatic hypotension, is considered present when there is a decrease of at least 20 mmHg in systolic blood pressure or 10 mmHg in diastolic blood pressure within three minutes of standing, as defined by the 2018 ESC guidelines for the diagnosis and management of syncope 1. This condition is characterized by a drop in blood pressure when a person changes position from lying down to sitting or standing, accompanied by symptoms like dizziness, lightheadedness, or fainting. Some key points to consider:
- The pathophysiology of orthostatic hypotension involves a mismatch between cardiac output and total peripheral resistance, leading to pooling of blood and a decrease in blood pressure 1.
- Common causes of orthostatic hypotension include dehydration, certain medications (especially antihypertensives, antidepressants, and diuretics), prolonged bed rest, neurological disorders, and aging.
- Management of orthostatic hypotension typically involves addressing the underlying cause, ensuring adequate hydration, rising slowly from lying or sitting positions, increasing salt intake if appropriate, wearing compression stockings, and in some cases, medications like fludrocortisone or midodrine 1.
- Lifestyle modifications are usually the first line of treatment before considering pharmacological interventions.
- It's worth noting that classical orthostatic hypotension is associated with increased mortality and cardiovascular disease prevalence, highlighting the importance of proper diagnosis and management 1.
From the Research
Definition of Positive Orthostatics
- Positive orthostatics is not directly defined in the provided studies, but we can infer that it may be related to the treatment of dystonia and other movement disorders.
- Dystonia is a neurological movement disorder characterized by involuntary muscle contractions, which can cause repetitive movements or abnormal postures 2, 3.
Treatment of Dystonia
- Botulinum toxin (BT) is a commonly used treatment for dystonia, which works by producing a peripheral paresis that is localized, well-controllable, and follows a distinct and predictable time course of around 3 months 2.
- Other treatments for dystonia include anticholinergic drugs, dopamine modulators, baclofen, muscle relaxants, and deep brain stimulation 3, 4.
- Combination therapy with multiple agents, such as aripiprazole, trihexyphenidyl, and botulinum toxin, may be effective in treating segmental craniocervical dystonia (Meige syndrome) 5.
Comparison of Treatments
- A prospective, randomized, double-blind controlled trial compared the effectiveness of botulinum toxin type A (BTA) with trihexyphenidyl in treating idiopathic cervical dystonia (ICD), and found that BTA was significantly more effective with fewer adverse effects 6.
- Deep brain stimulation (DBS) is also a treatment option for dystonia, and research has expanded to include new targets such as the subthalamic nucleus (STN) and other areas 4.