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.
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:
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.
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:
The risk factors for orthostatic hypotension include:
Medications. These include medications used to treat high blood pressure or heart disease, such as diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and nitrates.
Other medications that can increase the risk of orthostatic hypotension include medications used to treat Parkinson's disease, certain antidepressants, certain antipsychotics, muscle relaxants, medications to treat erectile dysfunction and narcotics.
Persistent orthostatic hypotension can cause serious complications, especially in older adults. These include:
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:
Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and sometimes to the arms or legs. Wires connect to a machine, which prints or displays results. An ECG can show changes in the heart rhythm or heart structure and problems with the supply of blood and oxygen to the heart muscle.
An ECG may not detect occasional heart rhythm changes. Your health care provider may recommend monitoring your heartbeat at home. A portable ECG device, called a Holter monitor, can be worn for a day or more to record the heart's activity during daily activities.
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.
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.
Some simple steps can help manage or prevent orthostatic hypotension. These include:
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.
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:
All medications, vitamins or supplements you take, including doses. Or bring in the bottles of all the medications you take.
Some medications — such as cold medicines, antidepressants, birth control pills and others — can affect your blood pressure. Don't stop taking any prescription medications that you think might affect your blood pressure without your care provider's advice.
Questions to ask your care provider.
Be prepared to discuss your diet and exercise habits, especially the amount of salt in your diet. If you don't already follow a diet or exercise routine, be ready to talk to your provider about challenges you might face in getting started.
For orthostatic hypotension, questions to ask your health care provider include:
Don't hesitate to ask other questions.
Your health care provider will likely ask you questions, such as:
