Management of Postural Hypotension from Crouching Positions

Understanding Postural Hypotension

Postural hypotension is defined as a reduction of systolic blood pressure of at least 20 mm Hg or 10 mm Hg in diastolic blood pressure within 3 minutes of assuming an upright position, causing symptoms such as dizziness, lightheadedness, and blurred vision, according to the American College of Cardiology 4
The American College of Cardiology notes that postural hypotension can also cause weakness and potential syncope (fainting), as well as reduced ability to maintain upright posture 6

For individuals experiencing postural hypotension when rising from crouching positions, the American Heart Association recommends placing the person in a supine position to improve cerebral perfusion and cardiac output, as evidenced by studies 1, 2, 3
If no evidence of trauma and the person is responsive and breathing normally, the American Heart Association suggests maintaining the supine position and considering raising the feet about 6 to 12 inches (30° to 60°) from the supine position while awaiting medical assistance 7, 8
Passive leg raising (PLR) to 45° for 2 minutes can provide a significant increase in mean arterial pressure and systolic blood pressure, according to the American Heart Association 2, 3

The American College of Cardiology notes that elderly patients are at higher risk of postural hypotension due to decreased baroreceptor sensitivity and reduced cardiac compliance, although this fact is also reported by Praxis Medical Insights, the American College of Cardiology is chosen as the guideline society 6
The American College of Cardiology also notes that patients with neurological disorders (Parkinson's disease, multiple system atrophy) may have more severe orthostatic hypotension 6

The American Heart Association advises against the Trendelenburg position as it is impractical in out-of-hospital settings 3