What Is Orthostatic Hypotension? Everything to Know

Medically Reviewed By Megan Soliman, MD
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Orthostatic hypotension, or postural hypotension, refers to a sudden drop in blood pressure when standing up from sitting or lying down. It can make you feel dizzy or lightheaded, and it may also cause you to faint. When you stand up, your body changes the way it pumps blood. When this change happens too slowly, it can temporarily reduce blood flow to the brain. In turn, this can make you feel dizzy and may result in fainting.

Read on to learn more about the condition, including what can cause it, how to treat it, and when to contact a doctor.

How common is orthostatic hypotension?

a person is standing up from an armchair
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Around 6% of people experience orthostatic hypotension. It is more prevalent among older adults, affecting around 18.2% of people over age 65.

The condition is more likely to occur if you have a cardiovascular condition, such as:

Young and middle-aged adults are more likely to experience orthostatic hypotension if they have chronic autonomic failure.

What causes orthostatic hypotension to occur?

Causes of orthostatic hypotension can be either neurogenic or non-neurogenic. Non-neurogenic causes are more common than neurogenic causes.

However, it is not possible to identify the cause of orthostatic hypotension in about 40% of cases.

Neurogenic causes

Neurogenic causes refer to orthostatic hypotension that occurs due to problems with the autonomic nervous system, which controls blood pressure.

The autonomic nervous system makes your heart beat faster when you stand up from sitting or lying down. The faster heart rate increases blood pressure and flow to work against the gravity affecting blood movement.

When the autonomic nervous system does not respond as it should, your body cannot pump blood quickly enough. This results in dizziness and fainting.

Neurogenic orthostatic hypotension can often happen alongside conditions affecting the nervous system, such as:

Non-neurogenic causes

Non-neurogenic causes of orthostatic hypotension can include:

  • drinking alcohol
  • heart disease
  • hypovolemia or low blood volume
  • medications, such as:
    • antidepressants
    • antipsychotics
    • diuretics
    • vasodilators for treating high blood pressure
    • beta-blockers
    • calcium channel blockers
    • angiotensin-converting enzyme (ACE) inhibitors
  • prolonged bed rest
  • pregnancy
  • dehydration or fluid loss due to bleeding, vomiting, or diarrhea

Learn more about possible causes of low blood pressure.

What are the symptoms of orthostatic hypotension?

You may experience a range of symptoms when you stand up if you have orthostatic hypotension.

Symptoms you may experience when standing up after a period of sitting or lying down can include:

In some cases, your drop in blood pressure may be severe enough to result in fainting or loss of consciousness, also called syncope.

Contact your doctor if you frequently experience any of these symptoms when standing up.

How is orthostatic hypotension treated?

It is possible to treat orthostatic hypotension with medication. You can also take steps to alleviate symptoms at home.

Home remedies

Home remedies for treating orthostatic hypotension typically involve changes to your daily routine. Steps you can take to help reduce your risk of orthostatic hypotension include:

  • drinking plenty of water to avoid dehydration
  • eating smaller meals more frequently
  • avoiding drinking alcohol or reducing your intake
  • adding more salt to your diet if you do not have high blood pressure
  • rising more slowly from sitting or lying to standing
  • avoiding standing upright for long periods of time
  • exercising in the morning if your blood pressure is higher later on in the day
  • elevating the head of your bed by a few degrees

Medical treatments

Your doctor may prescribe medication to help you manage orthostatic hypotension symptoms. These can include:

  • fludrocortisone
  • droxidopa
  • midodrine

If your symptoms occur due to medication you currently take, your doctor will recommend that you stop taking this medication. They can advise you on suitable alternatives.

Can orthostatic hypotension go away on its own?

If you experience orthostatic hypotension due to an underlying medical condition, treatment for that medical condition may help reduce your symptoms. This means that you might not have to address orthostatic hypotension directly.

Treating orthostatic hypotension directly does not always require medication. Making changes to your daily routine can help reduce and manage your symptoms.

Your doctor will advise on the best treatment options for you, depending on the condition’s cause.

What should my blood pressure reading be?

Your blood pressure reading comprises two numbers: systolic pressure and diastolic pressure.

The top number is systolic pressure, the pressure when your heart pumps blood around the body. The bottom number is diastolic pressure, referring to the pressure when your heart rests between beats.

Measurements are presented as systolic over diastolic in millimeters of mercury (mmHg), or systolic/diastolic mmHg.

See the table below for information about optimal blood pressure readings and when your blood pressure might be too high or too low.

Blood pressure reading
Low blood pressure90/60 mmHg or lower
Optimal blood pressure90/60–120/80 mmHg
High blood pressure140/90 mmHg or higher

Using a home blood pressure monitor can help you monitor your blood pressure. Keep a record of readings and show them to your doctor whenever you have an appointment to discuss your symptoms.

Orthostatic hypotension is based on the amount your blood pressure drops upon standing. Due to the drastic change, you may still experience the condition while your blood pressure is in the standard range.

Find out more about blood pressure readings.

When should I contact a doctor?

Contact your doctor if you frequently experience dizziness, lightheadedness, or fainting when standing up after sitting or lying down. You may also have these symptoms if you have been standing up for long periods.

Make sure your doctor is aware of any medication you are taking that could be contributing to your symptoms.

How is orthostatic hypotension diagnosed?

To diagnose orthostatic hypotension, your doctor will evaluate your medical history and carry out a physical examination.

They will take your blood pressure, measuring it when you lie down and change from sitting to standing. Your doctor may use a tilt table to assist with this, tilting your body at different degrees.

Your doctor may also arrange for laboratory tests to rule out non-neurologic causes. These tests can include:

  • complete blood count
  • electrolyte assessment
  • blood glucose level

What are the risk factors for orthostatic hypotension?

Certain risk factors make orthostatic hypotension more likely to occur. These can include:

  • being in warm weather, particularly if you do not drink enough water
  • rising at a certain time of day, such as first thing in the morning when you wake up
  • eating larger meals
  • drinking alcohol
  • exercising
  • standing for long periods of time
  • taking certain medications
  • aging, as problems with the autonomic nervous system can increase over time

Contact your doctor if you are concerned about the risks of orthostatic hypotension.

Can I prevent orthostatic hypotension?

Depending on the cause of orthostatic hypotension, you may be able to prevent it from happening. Steps you can take to minimize risks include:

  • drinking more water if it occurs due to dehydration
  • eating smaller, more frequent meals
  • avoiding alcohol
  • refraining from standing up for long periods of time
  • changing any medication that causes your symptoms, if your doctor advises it

Avoid standing up too quickly, as this can cause a sudden drop in blood pressure. Instead, rise slowly and steadily from your seat. You may also benefit from using the arms of the chair or another aid to help with balance.

Carrying out some exercises just before you stand up can also help reduce the risk of symptoms. The following steps might help:

  1. Bend your feet up and down at the ankle.
  2. Clench your hands and then unclench.
  3. Cross and then uncross your legs.
  4. Stretch out your arms and legs.

These steps can help encourage blood circulation, which may reduce the risk of a sudden drop in blood pressure when you stand up.

Are there any complications of orthostatic hypotension?

Without treatment, there may be complications of orthostatic hypotension. These may occur due to a reduction of blood flow to the organs and can include:

You may also experience an injury from a fall if orthostatic hypotension causes you to faint. It is important to rise slowly and steadily to help to minimize this risk.

Summary

Orthostatic hypotension is a drop in blood pressure when you stand up after sitting or lying down. It can make you feel dizzy and lightheaded, and it may result in fainting.

The condition can occur as a result of either neurogenic or non-neurogenic causes. In some cases, medical professionals cannot determine the cause of the symptoms.

Contact your doctor if you have concerns about orthostatic hypotension. They will be able to monitor your blood pressure and advise on the best type of treatment for you.

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Medical Reviewer: Megan Soliman, MD
Last Review Date: 2022 May 31
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