Orthostatic hypotension, also called postural hypotension, is a sudden drop in blood pressure that occurs when you stand up quickly.
When you stand up, gravity pulls blood into your legs and your blood pressure begins to fall. Certain reflexes in your body compensate for this change. Your heart beats faster to pump more blood, and your blood vessels constrict to prevent blood from pooling in your legs.
Certain drugs can affect these normal reflexes and lead to orthostatic hypotension. These reflexes may also begin to weaken as you age. For this reason, orthostatic hypotension is more common in older adults.
In fact, according to a 2021 research review, about 28 percent of the general population of older adults is affected by orthostatic hypotension.
The condition is often mild, lasting for just a few minutes after standing, but more severe cases can cause people to faint or lose consciousness.
Other common symptoms include:
Less common symptoms include:
Orthostatic hypotension can be a temporary issue, or it can be chronic. Many times, the exact cause of this condition isn’t known. Other times, there are direct causes, such as medications and chronic bleeding.
Some other known causes of orthostatic hypotension include:
- certain chemotherapy drugs
- vasodilator drugs (such as those that treat high blood pressure and Parkinson’s disease)
- some antipsychotic drugs
- some antidepressants
- alcohol intake
- hypovolemia (low blood plasma)
- cardiac pump failure
- venous pooling (when gravity causes blood to pool in the stomach and legs)
- underlying conditions that cause the malfunction of the autonomic nervous system (such as Parkinson’s disease)
- certain spinal cord problems
- Guillain-Barré syndrome
Certain risk factors can increase the possibility that you may experience orthostatic hypotension. Some individuals who are more at risk include:
- older people (age 65 and older), especially those who spend a lot of time lying down
- people who have recently given birth
- individuals who have been on bed rest
- teenagers (because of how fast they are growing in a shorter period of time)
Orthostatic hypotension occurs more often in the morning and may also occur an hour or two after a large meal, especially one high in carbohydrates.
A common complication of orthostatic hypotension is syncope, which is a temporary loss of consciousness (otherwise known as fainting). Injuries related to fainting and falling are another possible complication, especially in older adults.
Additionally, living with blood pressure that frequently drops and rises can increase the risk of stroke and other cardiovascular conditions.
If your doctor suspects that you have orthostatic hypotension, they will check your blood pressure while you’re sitting, lying down, and standing.
Your doctor can diagnose orthostatic hypotension if your systolic blood pressure (the top number) drops by
To find the underlying cause, your doctor may also:
- conduct a physical exam
- check your heart rate
- order certain tests
The tests your doctor may order include:
- complete blood count to check for anemia
- electrocardiogram to check the rhythm of your heart
- echocardiogram to check how your heart and heart valves are functioning
- exercise stress test, which measures your heart rate during exercise
- tilt-table test, in which you lie on a table that moves from horizontal to upright to test for fainting
These tests are performed to rule out other conditions such as Parkinson’s disease, diabetes, anemia, and postural tachycardia syndrome.
Treating orthostatic hypotension can be a bit of a challenge at times because there are a variety of causes. The main goal of treatment is to improve blood pressure once you stand up without increasing blood pressure when you’re lying down.
If medication is causing the condition, the first course of action would be to change or discontinue the medication.
If you’re living with Parkinson’s disease, diabetes, or another condition that is causing the orthostatic hypotension, treatment will likely be focused on treating the underlying condition first.
People living with orthostatic hypotension who do not experience symptoms will most likely not need treatment.
If you’re experiencing dizziness or fainting spells often, it’s important to check in with a doctor as soon as possible to rule out a more serious issue.
Once they diagnose your condition, your doctor may recommend some lifestyle changes that may help lessen your symptoms, including:
- increasing your fluid and water intake and limiting your alcohol intake if you’re dehydrated
- performing isometric exercises before getting up to help raise your blood pressure (for example, squeezing a rubber ball or a towel with your hand)
- avoiding hot baths or long walks in hot weather
- standing up slowly
- wearing compression stockings to help with circulation in your legs
- adding salt to your daily meals to help you retain fluid
For severe cases, your doctor may prescribe drugs that work to increase blood volume or constrict blood vessels. These drugs might include:
- fludrocortisone (Florinef)
- midodrine (ProAmatine)
- erythropoietin (Epogen, Procrit)
Orthostatic hypotension can be caused by a variety of issues, from dehydration to serious conditions such as Parkinson’s disease.
When the condition isn’t chronic (caused by another health issue), it typically goes away on its own. With a more chronic case, treating the underlying condition can help manage the orthostatic hypotension. Occasionally, people who experience orthostatic hypotension can reduce or eliminate symptoms by taking certain medications.