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Stand Up! Are there gender differences in orthostatic hypotension (‘head rush’)?

December 7, 2015 by Vicki Doe

Brandon Pollock PhD, ACSM-EP-C

Diagnosis - Hypotension. Medical Concept. 3D Render.

 

Proper redistribution of blood flow is of paramount importance both at rest and during exercise. Orthostatic hypotension, also known as postural hypotension, is a form of low blood pressure that occurs upon standing. In a healthy individual, in order to properly redistribute blood flow to the head, heart rate and blood pressure increase in response to standing. Orthostatic hypotension occurs when this response fails and blood remains to pool in the legs, resulting in decreased blood flow to the head. Many individuals describe experiencing orthostatic hypotension as a ‘head rush’, and symptoms include dizziness, blurred vision, nausea, headaches, lightheadedness, and in some cases even fainting.

Orthostatic hypotension is diagnosed as a drop in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg when a person assumes a standing position. Clinically, this is usually diagnosed through the use of a tilt table or lower body negative pressure.

Orthostatic hypotension, common in the elderly

Orthostatic hypotension is more common in the elderly and certain special populations, such as Parkinson’s disease. Interestingly, research now also suggests that females may experience more frequent symptoms of orthostatic hypotension compared to males.  Reports suggest there are gender-specific differences in either nerve activity or blood flow responses, which may be responsible for females’ reduced orthostatic tolerance.  In addition, women have been shown to respond primarily with vagal withdrawal while men show greater sympathetic activity. This is still somewhat controversial and the complicating roles played by comorbid factors and hormonal mechanisms are not well understood.

Recently as part of my doctoral dissertation, our lab investigated the influence gender has on functional sympatholytic, a specific physiological response involved in the prevention of orthostatic hypotension. Although we found no significant differences between our males and females, we observed differences in heart rate responses suggesting the possibility that gender could in fact influence orthostatic intolerance.

So what could this all mean? A greater prevalence of orthostatic intolerance in females would predispose them to experience greater orthostatic hypotension and risk of syncope (fainting), especially during exercise. As of now, our research and that of previous investigators suggest that this may be the case. However, this is still controversial and future investigations are warranted to further determine whether gender differences are present in orthostatic hypotension and any of the associated physiological responses.

Article's Sources

Cheng, Y. C., Vyas, A., Hymen, E., & Perlmuter, L. C. (2011). Gender differences in orthostatic hypotension. Am J Med Sci, 342(3), 221-225. doi: 10.1097/MAJ.0b013e318208752b

 Convertino, V. A. (1998). Gender differences in autonomic functions associated with blood pressure regulation. Am J Physiol, 275(6 Pt 2), R1909-1920.

 Hachiya, T., Hashimoto, I., Saito, M., & Blaber, A. P. (2012). Peripheral vascular responses of men and women to LBNP. Aviat Space Environ Med, 83(2), 118-124.

 Hogarth, A. J., Mackintosh, A. F., & Mary, D. A. (2007). Gender-related differences in the sympathetic vasoconstrictor drive of normal subjects. Clin Sci (Lond), 112(6), 353-361. doi: 10.1042/CS20060288

 Kelly, D. E., Scroop, G. C., Tonkin, A. L., & Thornton, A. T. (2004). Cardiovascular responses to orthostatic and other stressors in men and women are independent of sex. Clin Exp Pharmacol Physiol, 31(1-2), 50-56.

 Swain, David P., American College of Sports Medicine., & American College of Sports Medicine. (2014). ACSM's resource manual for Guidelines for exercise testing and prescription (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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© Copyright 2014-2022 Vicki Doe Fitness · Haywood Doe Consulting Co.,LLC· DBA Vicki Doe Fitness· All Rights Reserved

Filed Under: Ask the Experts Tagged With: blood flow, Brandon Pollock, diastolic blood pressure, head rush, heart rate, men, orthostatic hypotension, PhD, systolic blood pressure, vagal withdrawal, Vicki Doe Fitness, women

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