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Orthostatic hypotension (postural hypotension)

Medically reviewed by Drugs.com. Last updated on May 26, 2022.

Overview

Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting.

Orthostatic hypotension can be mild. Episodes might be brief. However, long-lasting orthostatic hypotension can signal more-serious problems. It's important to see a health care provider if you frequently feel lightheaded when standing up.

Occasional orthostatic hypotension is usually caused by something obvious, such as dehydration or lengthy bed rest. The condition is easily treated. Chronic orthostatic hypotension is usually a sign of another health problem, so treatment depends on the cause.

Symptoms

The most common symptom of orthostatic hypotension is lightheadedness or dizziness when standing after sitting or lying down. Symptoms usually last less than a few minutes.

Orthostatic hypotension signs and symptoms include:

When to see a doctor

Occasional dizziness or lightheadedness can be minor — triggered by mild dehydration, low blood sugar or overheating. Dizziness or lightheadedness can also result from standing after sitting for a long time. If these symptoms happen only occasionally, there's likely no cause for concern.

It's important to see a health care provider for frequent symptoms of orthostatic hypotension. Losing consciousness, even for just a few seconds, is serious. It requires seeing a provider right away.

Keep a record of your symptoms, when they occurred, how long they lasted and what you were doing at the time. Tell your care provider if symptoms occur at times that could be dangerous, such as while driving.

Causes

When standing from a sitting or lying position, gravity causes blood to collect in the legs and belly. Blood pressure drops because there's less blood flowing back to the heart.

Usually, special cells (baroreceptors) near the heart and neck arteries sense this lower blood pressure. The baroreceptors send signals to the brain. This tells the heart to beat faster and pump more blood, which evens out blood pressure. These cells also narrow the blood vessels and increase blood pressure.

Orthostatic hypotension occurs when something interrupts the body's process of dealing with the low blood pressure. Many conditions can cause orthostatic hypotension, including:

Risk factors

The risk factors for orthostatic hypotension include:

Complications

Persistent orthostatic hypotension can cause serious complications, especially in older adults. These include:

Diagnosis

A health care provider's goal in evaluating orthostatic hypotension is to find the cause and determine treatment. The cause isn't always known.

A care provider might review medical history, medications and symptoms and conduct a physical exam to help diagnose the condition.

A provider also might recommend one or more of the following:

Tilt table test

Someone having a tilt table test begins by lying flat on a table. Straps hold the person in place. After lying flat for a while, the table is tilted to a position that mimics standing. The health care provider watches how the heart and the nervous system that controls it respond to the changes in position.

Treatment

Treatment for orthostatic hypotension is directed at the cause rather than the low blood pressure itself. For example, if dehydration causes orthostatic hypotension, your health care provider may suggest lifestyle changes such as drinking more water. If a medication causes low blood pressure when standing, treatment may involve changing the dose or stopping the drug.

For mild orthostatic hypotension, one of the simplest treatments is to sit or lie back down immediately after feeling lightheaded upon standing. Often, symptoms will disappear. Sometimes, medications are needed to treat orthostatic hypotension.

Medications

If orthostatic hypotension doesn't improve with lifestyle changes, medications may be needed to increase blood pressure or blood volume. The type of medication depends on the type of orthostatic hypotension.

Drugs that may be used to treat orthostatic hypotension include midodrine (Orvaten), droxidopa (Northera), fludrocortisone or pyridostigmine (Mestinon, Regonol).

Talk to your health care provider about the risks and benefits of these drugs to determine which one is best for you.

Self care

Some simple steps can help manage or prevent orthostatic hypotension. These include:

Compression stockings

Compression stockings, also called support stockings, press on the legs, improving blood flow. A stocking butler may help with putting on the stockings.

Preparing for your appointment

You don't need to do anything special before having your blood pressure checked. But it's helpful to wear a short-sleeved shirt or a loose long-sleeved shirt that can be pushed up during the test. Doing so helps with fitting the blood pressure cuff around the arm properly.

Take your blood pressure regularly at home, and keep a log of your readings. Bring the log with you to your health care provider's appointment.

Take your blood pressure first thing in the morning. Lie down for the first reading. Complete taking your blood pressure, then wait one minute. Stand and take the second reading.

Also take your blood pressure at these times:

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet for a blood test. Plan to bring a family member or friend to your appointment, if possible, to help you remember all the information you're given.

Make a list of the following:

For orthostatic hypotension, questions to ask your health care provider include:

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider will likely ask you questions, such as:

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