Orthostatic Hypotension

(Postural Hypotension)

by Cynthia M. Johnson, MA

Definition

Orthostatic hypotension is a sudden drop in blood pressure when a person stands.

Measuring of Blood Pressure

Causes

There are many causes. Some common ones are:

Side effects from some medicines, such as blood vessel dilators and diuretics
Fluid loss due to bleeding, vomiting, diarrhea, or dehydration
Problems with the way the heart functions due to things like anemia, changes in rhythm, and heart failure
Endocrine problems, such as diabetes and hypothyroidism
Prolonged bedrest

Risk

This problem is more common in people who are over 55 years of age, especially those with poorly controlled high blood pressure. Other things that may raise the risk are:

Longer periods of standing, mainly in heat
Long term or regular use of some medicines, such as diuretics and blood vessel dilators
Having certain heart or endocrine problems

Symptoms

Problems may be:

Lightheadedness
Blurred eyesight
Weakness
Fatigue
Fainting

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. Your blood pressure will be measured going from lying down or sitting to standing. This may also be done using a tilt-table. This is all that is needed to make the diagnosis.

Treatment

The goal of treatment is to ease or manage symptoms. This may include treating underlying health problems and:

Changing or stopping medicines that cause problems
Drinking plenty of water to treat or avoid dehydration
Eating smaller meals more often
Limiting or not drinking alcohol
Increasing salt in people who do not have high blood pressure
Slowly rising from a seated position and not standing for long periods of time

Prevention

There are no guidelines to prevent this problem. Older adults should talk to their doctors about the medicines they take.

Resources:

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov

National Organization for Rare Disorders

http://www.rarediseases.org

Canadian resources:

Health Canada

https://www.canada.ca/en/health-canada.html

Heart and Stroke Foundation

http://www.heartandstroke.ca

References:

Orthostatic hypotension information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Orthostatic-Hypotension-Information-Page. Updated March 27, 2019. Accessed December 10, 2019.

Orthostatic hypotension and orthostatic syncope. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/orthostatic-hypotension-and-...hostatic-syncope. Updated February 26, 2019. Accessed December 10, 2019.

3/24/2015 DynaMed Systematic Literature Surveillance https://www.dynamed.com/condition/orthostatic-hypotension-and-...hostatic-syncope: Mills PB, Fung CK, et al. Nonpharmacologic management of orthostatic hypotension: A systematic review. Arch Phys Med Rehab. 2015;96(20):366-375.

Last reviewed September 2019 by EBSCO Medical Review Board James Cornell, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.