There are several causes actually. When talking about hypertension, there are various types of causes.
Basically, postural hypertension is a general category or a broad heading. Under postural hypertension, there are various types of things like Vasovagal, things like POTS (Postural orthostatic tachycardia syndrome), which has a few types, Type I and Type II, then there is also those that are related due to medication, and those due to dehydration.
In cardiac terms, usually for patients with postural hypertension, we first try to rule out the reversible causes. So simple things like medication, hydration status, and when you come to a cardiologist, we will want to rule out the cardio stuff.
So we do things like the tilt table test to see whether they have the Vasovagal type of postural hypertension. The more alarming part will be when the heart rate drops alarming low and they have a pause in the conduction before the blood pressure drops.
But in those cases, there is a difference between diagnosing and treatment. Let's say I know I'm going to know in 4 months time, will it be useful knowledge if there is nothing I can do about it? No, it just makes me worried and anxious. Maybe it will make me spend a little more time with your loved ones. That is about it.
It is the same with this tilt table testing. It is useful in terms of finding out the types of causes but in terms of treatment wise, the most extreme treatment one can think of is an implantation of a pacemaker, for the cardiac type.
In this case, again, it depends on why the patient wants to put in the pacemaker. Because, the pacemaker will not stop you from fainting, for example, because by the time it detects your heart rate, the heart will have a long enough pause, you will have fainted.
So, you will probably faint for a shorter period of time. That means you faint then wake up again, but if your main concern was you fainting in the first place, that may not really help. So, treatment wise medication for such a group of patients is usually quite limited.
So basically medicine-related causes, things that can drop your blood pressure, hydration status, if you are dehydrated. These are all medicine-related.
If your cause is physiological, note that even young people can get this, people with a higher vagal tone tend to have postural giddiness as well. So usually, the conservative treatment we usually advise are things like adequate hydration, which is why your army has all the water parade.
Then we actually talk about exercises, because having a strong Peripheral muscle is like what you call a Peripheral pump. So our heart is like a pump. This is useful for people who don't usually exercise; They have these postural symptoms when they are young.
The third thing is that for the elderly folks who are more prone to this postural drop, we give them postural advice.
