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Initial orthostatic hypotension is frequently characterized by a systolic blood pressure decrease of ≥40 mmHg or diastolic blood pressure decrease of ≥20 mmHg within 15 seconds of standing. [32] Blood pressure then spontaneously and rapidly returns to normal, so the period of hypotension and symptoms is short (<30 s). [ 32 ]
Serious side effects may include low blood pressure or heart attack. [10] Whether use is safe during pregnancy or breastfeeding is unclear. [2] [10] When used by people with liver problems, and in elderly individuals, doses should be reduced. [10] Amlodipine works partly by vasodilation (relaxing the arteries and increasing their diameter). [10]
All of these mechanisms make POTS patients' hearts work harder to cause the same response: increased heart rate after a few minutes of standing and not enough blood flow to the brain.
A patient is considered to have orthostatic hypotension when the systolic blood pressure falls by more than 20 mm Hg, the diastolic blood pressure falls by more than 10 mm Hg, or the pulse rises by more than 20 beats per minute within 3 minutes of standing [5] [7]
Orthostatic intolerance occurs in humans because standing upright is a fundamental stressor, so requires rapid and effective circulatory and neurologic compensations to maintain blood pressure, cerebral blood flow, and consciousness. When a human stands, about 750 ml of thoracic blood are abruptly translocated
A lower resting heart rate or slower heartbeat will fill the ventricles/heart better and allow for more of a forceful contraction of blood out to the rest of the body, says Dr. Weinberg.
Since blood pressure is in intimate feedback with cardiac output and peripheral resistance, with relatively low blood pressure, the afterload on the heart decreases; this decreases how hard the heart must work to eject blood into the aorta, so the amount of oxygen required by the heart decreases accordingly.
In pooled data, from three comparative studies conducted in 200 patients with mild to moderate hypertension, 2.5 mg of levamlodipine was found to be equivalent in its blood pressure lowering efficacy to 5 mg of amlodipine. The average reduction in systolic BP was 19±3 vs 19±4, 20±2 vs 19±3 and 20±2 vs 19±3 mm of Hg recorded in standing ...