Orthostatic Hypotension

Orthostatic hypotension (postural hypotension) is a sudden drop in blood pressure when you stand after sitting or lying down. You may feel dizzy or even faint. This can happen for many reasons, like a loss of blood or fluids or a heart issue. Treating the causes improves symptoms.

This condition affects many people over 60, especially those who live in long-term care residences. It’s also common among people who’ve been on bed rest or given birth recently. Teens having growth spurts can experience it as well.

Postural hypotension happens more frequently — and with more severe symptoms — in the morning. That’s because blood pressure is normally at its lowest when you wake up in the morning.

With orthostatic hypotension, your heart rate doesn’t increase. This makes it different from postural orthostatic tachycardia syndrome (POTS).

Symptoms of orthostatic hypotension

The main symptom of orthostatic hypotension is dizziness or lightheadedness when you stand. Some people faint. You should feel better when you sit or lie down.

Other orthostatic hypotension symptoms include:

• Blurred vision
• Chest pain, shoulder pain or neck pain
• Confusion
• Fatigue or weakness
• Headaches
• Heart palpitations
• Nausea or feeling hot and sweaty
• Shortness of breath

Some people don’t have any orthostatic hypotension symptoms. Others find that hot temperatures (from the weather, a fever, or even a hot tub or shower) make symptoms worse.

Orthostatic hypotension causes

This condition happens when your body can’t adjust to a large amount of blood moving to your lower body when you stand. This amount of blood could fill a large coffee cup or a water bottle.

When you’re sitting or lying down, blood from the veins in your legs flows easily to your heart. When you stand up, the blood in your legs and feet has a harder time reaching your heart. There’s less blood available for your heart to send to organs and muscles. As a result, your blood pressure briefly drops.

Postural hypotension causes may include:

• Heart issues: Your heart can’t pump as much blood as it should because of an abnormal heart rhythm, heart failure or heart attack.
• Autonomic nervous system problems: This system, which usually brings your blood pressure back to normal, isn’t working right because of Parkinson’s disease, for example. When this system is the cause, it’s neurogenic orthostatic hypotension.
• Long-term bed rest: You’ve been lying down a long time (like if you're pregnant and on bed rest).
• Low blood volume: Your blood volume is low because you’ve lost blood or fluids through dehydration, anemia or injury.
• Medications: Your body’s reacting to a medication you’re taking for cancer, depression or high blood pressure.

Risk factors

Orthostatic hypotension becomes more common as you age. After 65, your body can’t manage blood pressure as well, and your arteries get stiff. But anyone can get this condition if they take certain medicines, have a heart condition, lose too much fluid or stand too long.

These factors increase your risk:

• Lack of nutrients: If you don’t get enough vitamin B12 and folic acid, it can cause anemia. This condition can lead to low blood pressure.
• Dehydration: This loss of fluids can come from diarrhea, vomiting or water pills (diuretics). Losing fluids lowers your volume of blood.
• Endocrine problems: This can include diabetes, low blood sugar, thyroid disease and Addison’s disease.
• Heart conditions: These include arrhythmias (abnormal heart rhythms), heart attack, heart failure and heart valve disease. Any of these can make it harder for your heart to pump the blood your body needs.
• Medications: Drugs that treat high blood pressure (hypertension), heart disease, Parkinson’s disease and depression can increase your risk of orthostatic hypotension.
• Neurological problems: These include Parkinson’s disease and dementia.
• Not moving for a long time: This may happen because of illness, including pregnancy bed rest. This also includes standing for a long time.

How to lower your risk

If you’re prone to postural hypotension, these steps can help reduce symptoms:

• Keep your temperature moderate. Don’t take very hot baths or showers.
• Stay hydrated and eat light. Drink plenty of water, limit alcohol and avoid heavy, high-carbohydrate meals.
• Raise your head. Elevate your head at night by using more pillows or raising the mattress.
• Get ready to stand. Give yourself more time to move into a standing position after sitting or lying down. Have something sturdy nearby to hold on to when you stand up.
• Move your muscles. March your feet if you must stand for prolonged periods. Do isometric exercises (squeeze a soft rubber ball or towel, or clench and unclench your hands) to raise blood pressure before standing.
• Improve blood circulation and pressure. Wear compression stockings or an abdominal binder (elastic that compresses your abdomen).

Complications of this condition

People with orthostatic hypotension may have a higher risk of:

• Bone fractures or concussions from falls when you feel dizzy or faint
• Low blood pressure 30 minutes to two hours after eating, particularly a high-carbohydrate meal
• Shock or organ failure if blood pressure stays too low
• Stroke or heart disease from changes in blood pressure
• Low blood pressure that occurs when lying down

How doctors diagnose orthostatic hypotension

Your healthcare provider will check your blood pressure while you’re sitting, lying down and standing. Healthcare providers diagnose this condition based on how low your blood pressure goes when you stand up. You meet the orthostatic hypotension criteria if your blood pressure drops more than 20 millimeters of mercury in systolic (top number) pressure or 10 mmHg in diastolic (bottom number) pressure within three minutes of standing up.

Your provider will examine you and ask questions about your medical history.

You may also get one or more of these tests:

• Blood tests to check for conditions like diabetes and anemia
• Echocardiogram (echo) to check your heart’s pumping action
• Electrocardiogram (EKG) to test for heart rhythm changes
• Exercise stress test to measure your heart rate during physical exertion
• Portable EKG devices to measure your heart rhythm over time
• Tilt table test to measure blood pressure, heart rate and heart rhythm while you lie on a table that safely moves you to a standing position

How is it treated?

Orthostatic hypotension treatments vary depending on what’s causing the condition. You may need to wear compression stockings, change a medication dose or take new medicine.

Treatments may include:

• Treating a condition or disease that’s causing orthostatic hypotension
• Changing the dose of a medication that causes this condition or switching to a different drug
• Sitting up in bed if you’re on bed rest
• Wearing elastic stockings on your legs or a binder on your belly
• Taking in fluids and salt

Rarely, people with postural hypotension need medications to increase blood volume and pressure. These medications include:

• Atomoxetine
• Droxidopa
• Desmopressin
• Octreotide
• Fludrocortisone
• Midodrine
• Pyridostigmine

When should I see my healthcare provider?

You should call a healthcare provider if you often get dizzy when you stand up. Contact them even if this only happens some of the time.

Get immediate treatment if you have:

• Chest pain
• Falls or fainting
• Trouble with your balance or coordination
• Suspected bone fractures or head injuries from falls
• Blood or a black color in your poop
• Signs of shock (cold, sweaty skin, rapid breathing, blue skin tone and weak pulse)

You may want to ask your healthcare provider:

• Why do I have orthostatic hypotension?
• What’s the best treatment for me?
• Could medications be causing my symptoms?
• What changes should I make to manage symptoms?

What can I expect if I have this condition?

There’s no cure for orthostatic hypotension, but it rarely causes long-term problems. Most people with this condition can manage symptoms by:

• Moving more slowly into a standing position
• Taking medication
• Eating small meals
• Drinking more fluids
• Wearing compression garments