Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.
Orthostatic hypotension may be mild and last for less than a few minutes. However, long-lasting orthostatic hypotension can signal more-serious problems, so it's important to see a doctor if you frequently feel lightheaded when standing up.
Occasional (acute) orthostatic hypotension is usually caused by something obvious, such as dehydration or lengthy bed rest, and is easily treated. Chronic orthostatic hypotension is usually a sign of another health problem, so treatment varies.
The most common symptom is lightheadedness or dizziness when you stand up after sitting or lying down. Symptoms usually last less than a few minutes.
Orthostatic hypotension signs and symptoms include:
Occasional dizziness or lightheadedness may be fairly minor — triggered by mild dehydration, low blood sugar or overheating. Dizziness or lightheadedness may also happen when you stand after sitting for a long time. If these symptoms happen only occasionally, there's likely no cause for concern.
It's important to see your doctor if you experience frequent symptoms of orthostatic hypotension because they can signal serious problems. It's even more urgent to see a doctor if you lose consciousness, even for just a few seconds.
Keep a record of your symptoms, when they occurred, how long they lasted and what you were doing at the time. If these occur at dangerous times, such as while driving, discuss this with your doctor.
When you stand up, gravity causes blood to pool in your legs and abdomen. This decreases blood pressure because there's less blood circulating back to your heart.
Normally, special cells (baroreceptors) near your heart and neck arteries sense this lower blood pressure. The baroreceptors send signals to centers in your brain, which signals your heart to beat faster and pump more blood, which stabilizes blood pressure. These cells also narrow the blood vessels and increase blood pressure.
Orthostatic hypotension occurs when something interrupts the body's natural process of counteracting low blood pressure. Many different 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 may increase your 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.
Using medications that treat high blood pressure in combination with other prescription and over-the-counter medications may cause low blood pressure.
Persistent orthostatic hypotension can cause serious complications, especially in older adults. These include:
Your doctor's goal in evaluating orthostatic hypotension is to find the underlying cause, and determine appropriate treatment for any health problems that may cause your low blood pressure. The cause isn't always known.
Your doctor may review your medical history, review your symptoms and conduct a physical examination to help diagnose your condition.
Your doctor also may recommend one or more of the following:
Electrocardiogram (ECG or EKG). This noninvasive test detects irregularities in your heart rhythm or heart structure, and problems with the supply of blood and oxygen to your heart muscle.
During this painless, noninvasive test, soft, sticky patches (electrodes) are attached to the skin of your chest, arms and legs. The patches detect your heart's electrical signals while a machine records them on graph paper or displays them on a screen.
Sometimes, heart rhythm abnormalities come and go, and an ECG won't find any problems. If this happens, you may be asked to wear a 24-hour Holter monitor to record your heart's electrical activity as you go about your daily routine.
Echocardiogram. In this noninvasive exam, sound waves are used to produce a video image of your heart. Sound waves are directed at your heart from a wandlike device (transducer) that's held on your chest.
The sound waves that bounce off your heart are reflected through your chest wall and processed electronically to provide video images of your heart in motion to detect underlying structural heart disease.
You begin by lying flat on a table. Straps are put around your body to hold you in place. After lying flat for awhile, the table is tilted to raise your body and head — simulating a change in position from lying down to standing up. During this test, your heart rate and blood pressure are monitored to evaluate your body's cardiovascular response to the change in position.
The goal of treatment for orthostatic hypotension is to restore normal blood pressure. That usually involves increasing blood volume, reducing the pooling of blood in your lower legs and helping blood vessels to push blood throughout your body.
Treatment often addresses the underlying cause — dehydration or heart failure, for example — rather than the low blood pressure itself.
For mild orthostatic hypotension, one of the simplest treatments is to sit or lie down immediately after feeling lightheaded upon standing. Your symptoms should disappear.
When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication or stopping it entirely.
Orthostatic hypotension treatments include:
Lifestyle changes. Your doctor may suggest several lifestyle changes, including drinking enough water; drinking little to no alcohol; avoiding overheating; elevating the head of your bed; avoiding crossing your legs when sitting; and standing up slowly.
If you don't also have high blood pressure, your doctor might suggest increasing the amount of salt in your diet. If your blood pressure drops after eating, your doctor may recommend small, low-carbohydrate meals.
Medications. Several medications, either used alone or together, can be used to treat orthostatic hypotension. For example, the drug fludrocortisone is often used to help increase the amount of fluid in your blood, which raises blood pressure. Midodrine raises standing blood pressure levels by limiting expansion of your blood vessels, which in turn raises blood pressure.
Droxidopa (Northera) may be prescribed to treat orthostatic hypotension associated with Parkinson's disease, multiple system atrophy or pure autonomic failure.
Other medications, such as pyridostigmine (Regonol, Mestinon), nonsteroidal anti-inflammatory drugs (NSAIDs), caffeine and epoetin (Epogen, Procrit, others), are sometimes used, too, either alone or with other medications for people who aren't helped with lifestyle changes or other medications.
Compression stockings, also called support stockings, compress your legs, promoting circulation. A stocking butler may help you put on the stockings.
Some simple steps help manage or prevent orthostatic hypotension. Your doctor may give you several suggestions, including:
No special preparations are necessary to have your blood pressure checked. But it's helpful if you wear a short-sleeved shirt or a loosefitting long-sleeved shirt that can be pushed up during your evaluation so that the blood pressure cuff can fit around your arm properly.
Take your blood pressure regularly at home, and keep a log of your readings. Bring the log with you to your doctor's appointment.
Take your blood pressure before and after each of the activities below. Lie down for the first reading. Complete the activity, then wait one minute. Stand and take the second reading.
Because appointments can be brief and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Your time with your doctor may be limited, so preparing a list of questions may help you make the most of your time together. List your questions from most important to least important in case time runs out. For low blood pressure, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
Your doctor will probably ask you questions. If you're prepared, you'll have more time to go over any topics you want to discuss. Your doctor may ask: