What is orthostatic hypotension?
Orthostatic hypotension, also called postural hypotension, is defined as a sudden drop in blood pressure caused by a change in posture, such as when a person stands up quickly.
How common is orthostatic hypotension?
Orthostatic hypotension is quite common. Please discuss with your doctor for further information.
What are the symptoms of orthostatic hypotension?
The common symptoms of orthostatic hypotension are:
- Feeling lightheaded or dizzy after standing up
- Blurry vision
- Fainting (syncope)
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
Occasional dizziness or lightheadedness may be fairly minor — triggered by mild dehydration, low blood sugar or overheating. Dizziness or lightheadedness may also happen when you stand after sitting for a long time. If these symptoms happen only occasionally, there’s likely no cause for concern.
It’s important to see your doctor if you experience frequent symptoms of orthostatic hypotension because they can signal serious problems. It’s even more urgent to see a doctor if you lose consciousness, even for just a few seconds.
Keep a record of your symptoms, when they occurred, how long they lasted and what you were doing at the time. If these occur at dangerous times, such as while driving, discuss this with your doctor.
What causes orthostatic hypotension?
Loss of fluid within the blood vessels is the most common cause of symptoms linked to orthostatic hypotension. This could be due to dehydration brought about by diarrhea, vomiting, and the use of medication, such as diuretics or water pills. This medication helps the body get rid of excess water and salt through urine.
Loss of blood, anemia, and other conditions that result in a lower red blood count are also likely causes. When there are fewer red blood cells available to carry oxygen in the bloodstream, dizziness and light-headedness may occur.
Some medications, such as beta-blockers and antidepressants, can also trigger symptoms linked to orthostatic hypotension. Working or exercising in hot weather or being bedridden for a prolonged period can also lead to these symptoms.
Parkinson’s disease, pregnancy, and heart conditions such as irregular heart rhythms and valve disease are also known to cause symptoms connected to orthostatic hypotension.
What increases my risk for orthostatic hypotension?
There are many risk factors for orthostatic hypotension, such as:
- Orthostatic hypotension is common in those who are age 65 and older. Special cells (baroreceptors) near your heart and neck arteries that regulate blood pressure can slow as you age. It also may be harder for an aging heart to beat faster and compensate for drops in blood pressure.
- These include medications used to treat high blood pressure or heart disease, such as diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and nitrates. Other medications that may increase your risk of orthostatic hypotension include medications used to treat Parkinson’s disease, certain antidepressants, certain antipsychotics, muscle relaxants, medications to treat erectile dysfunction and narcotics. Using medications that treat high blood pressure in combination with other prescription and over-the-counter medications may cause low blood pressure.
- Certain diseases. Some heart conditions, such as heart valve problems, heart attack and heart failure; certain nervous system disorders, such as Parkinson’s disease; and diseases that cause nerve damage (neuropathy), such as diabetes, increase the risk of low blood pressure.
- Heat exposure. Being in a hot environment can cause heavy sweating and possibly dehydration, which can lower your blood pressure and trigger orthostatic hypotension.
- Bed rest. If you have to stay in bed a long time because of an illness, you may become weak. When you try to stand up, you may experience orthostatic hypotension.
- Because your circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you’ve given birth.
- Drinking alcohol can increase your risk of orthostatic hypotension.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is orthostatic hypotension diagnosed?
If someone experiences any of the above symptoms, their doctor will look into their medical history. If needed, the doctor will then conduct tests to find out if an underlying condition or illness is causing the symptoms.
For example, if a particular medication is causing the blood pressure to drop, the doctor may adjust the dosage or recommend a switch to another drug.
A head-up tilt table test will look at how a person’s blood pressure reacts to changes in their body’s position. During this test, a person lies on a table that is slowly tilted upward.
Blood tests can show whether someone has low blood sugar or a low number of red blood cells, which are both signs of low blood pressure.
An electrocardiogram (ECG or EKG), which monitors the heart’s electrical signals, can uncover irregularities in heart rhythm and problems with blood and oxygen supply to the heart.
An ultrasound of the heart, or echocardiogram, assesses the heart valves using sound waves and could uncover underlying disorders.
A stress test can be conducted where a doctor monitors the heart while the person is exercising or after being given medication.
How is orthostatic hypotension treated?
The goal of treatment for orthostatic hypotension is to restore normal blood pressure. That usually involves increasing blood volume, reducing the pooling of blood in your lower legs and helping blood vessels to push blood throughout your body.
Treatment often addresses the underlying cause — dehydration or heart failure, for example — rather than the low blood pressure itself.
For mild orthostatic hypotension, one of the simplest treatments is to sit or lie down immediately after feeling lightheaded upon standing. Your symptoms should disappear.
When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication or stopping it entirely.
Orthostatic hypotension treatments include:
- Lifestyle changes. Your doctor may suggest several lifestyle changes, including drinking enough water; drinking little to no alcohol; avoiding overheating; elevating the head of your bed; avoiding crossing your legs when sitting; and standing up slowly. If you don’t also have high blood pressure, your doctor might suggest increasing the amount of salt in your diet. If your blood pressure drops after eating, your doctor may recommend small, low-carbohydrate meals.
- Compression stockings. Compression stockings and garments or abdominal binders may help reduce the pooling of blood in your legs and reduce the symptoms of orthostatic hypotension.
- Several medications, either used alone or together, can be used to treat orthostatic hypotension. For example, the drug fludrocortisone is often used to help increase the amount of fluid in your blood, which raises blood pressure. Midodrine raises standing blood pressure levels by limiting expansion of your blood vessels, which in turn raises blood pressure. Droxidopa (Northera) may be prescribed to treat orthostatic hypotension associated with Parkinson’s disease, multiple system atrophy or pure autonomic failure. Other medications, such as pyridostigmine (Regonol, Mestinon), nonsteroidal anti-inflammatory drugs (NSAIDs), caffeine and epoetin (Epogen, Procrit, others), are sometimes used, too, either alone or with other medications for people who aren’t helped with lifestyle changes or other medications.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage orthostatic hypotension?
The following lifestyles and home remedies might help you cope with orthostatic hypotension:
- Increase salt in your diet. This must be done carefully and only after discussing it with your doctor. Too much salt can cause your blood pressure to increase beyond a healthy level, creating new health risks.
- Eat small meals. If your blood pressure drops after eating, your doctor may recommend small, low-carbohydrate meals.
- Ask about vitamin supplements. Both anemia and vitamin B-12 deficiency can affect blood flow and worsen symptoms of orthostatic hypotension, so iron and vitamin supplements might be helpful for you if you’re deficient.
- Get plenty of fluids. Keeping hydrated helps prevent symptoms of low blood pressure. Drink plenty of water before long periods of standing, or any activities that tend to trigger your symptoms.
- Avoid alcohol. Alcohol can worsen orthostatic hypotension, so limit or avoid it completely.
- Regular cardiovascular and strengthening exercises may help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid weather. Stretch and flex your calf muscles before sitting up. If symptoms strike, squeeze your thigh, abdominal and buttock muscles. Squat, march in place or rise onto your tiptoes.
- Avoid bending at the waist. If you drop something on the floor, squat with your knees to recover it.
- Wear waist-high compression stockings. These may help improve blood flow and reduce the symptoms of orthostatic hypotension. Wear them during the day, but take them off for bed and anytime you lie down.
- Get up slowly. You may be able to reduce the dizziness and lightheadedness that occur with orthostatic hypotension by moving slowly from a lying to standing position. Also, when getting out of bed, sit on the edge of your bed for a minute before standing.
- Elevate your head in bed. Sleeping with the head of your bed slightly elevated can help fight the effects of gravity.
- Move your legs while standing. If you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Orthostatic hypotension (postural hypotension). https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548. Accessed November 27, 2017.
Orthostatic hypotension: Causes, symptoms, and prevention. https://www.medicalnewstoday.com/articles/318158.php. Accessed November 27, 2017.
Review Date: November 28, 2017 | Last Modified: November 28, 2017