What should transplant patients know about  orthostatic/postural hypotension?

What should transplant patients know about orthostatic/postural hypotension?

So orthostatic hypotension, also called postural hypotension, happens when people’s blood pressure drops when they are changing positions—either from sitting to standing or from lying down to standing. It’s a drop in blood pressure, and they may have symptoms because of that. The main symptoms are lightheadedness and feeling dizzy. Some patients may faint because there is not enough blood flow going to the brain.

What causes orthostatic/postural hypotension during the transplant process?

The causes are multiple during the transplant process. Some patients may get dehydrated because after chemotherapy they may feel nauseated, may not have an appetite, or may not feel like drinking enough fluids. Even though we stress the importance of hydration, some patients fall behind and get dehydrated, which can lead to orthostatic hypotension.

Sometimes this is related to medications. Certain medications we give to patients may produce this effect. Patients with a history of hypertension may still be taking blood pressure medications, but if they’re losing weight and eating less, their blood pressure naturally drops. Continuing those medications can lower it even more. So there’s constant adjustment of medications and making sure hydration remains good during the transplant process to avoid these issues.

This can also be related to prior treatment or chemotherapy given during transplant. For example, medications like Velcade can cause neuropathy. One type of neuropathy affects nerves that control communication between the heart and brain, which can lead to poor regulation of blood pressure when changing positions. Chemotherapy drugs like melphalan can also contribute.

How common is orthostatic/postural hypotension during the transplant process?

It’s fairly common. It’s so common that nursing staff have protocols for when to check for it. They’ve analyzed the times when it’s more likely and implemented checks at those points to prevent falls, which are a major concern. If a patient is found to have orthostatic hypotension, measures are put in place—for example, fall precautions in the hospital or ensuring someone assists them when walking.

In the outpatient setting, staff also monitor fluid intake closely to ensure patients are drinking enough. Sometimes IV fluids or medications that raise blood pressure, such as midodrine, are prescribed. Midodrine works by tightening blood vessels so blood pressure doesn’t drop when patients change position.

How do you monitor for orthostatic/postural hypotension?

Blood pressure is checked while the patient is lying down, then sitting, and then standing. The change in blood pressure between these positions helps determine if the patient has orthostatic hypotension. In addition, even though it’s not part of the formal criteria, changes in heart rate are also noted. Some people have an exaggerated increase in heart rate when they stand up, which is called postural tachycardia.

This change in heart rate can be an early sign of dehydration or an indication that postural hypotension may occur.