Orthostatic Hypotension

Orthostatic hypotension, also called postural hypotension, is defined as a sudden drop in blood pressure caused by a change in posture, such as when a person stands up quickly.

When a person stands up after sitting or lying down, blood normally pools in the legs because of gravity. The body then works to push blood upward to supply the brain with oxygen.

If the body is unable to do this sufficiently, blood pressure falls, which may lead to symptoms, such as dizziness, blurred visions, or fainting.

“Orthostasis” means “to stand up,” “hypotension” is the term for low blood pressure, and blood pressure is the force of your blood against the walls of your arteries.

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.

Hypotension, or low blood pressure, occurs when the blood pressure in the arteries falls below normal levels.

The heart pumps blood around the body through blood vessels. These tubular structures include arteries, veins, and capillaries. Blood pressure is a measure of the force of the blood on the walls of the arteries as it pumps through them.

Blood pressure is measured in millimeters of mercury (mmHg) and has two figures:

  • Systolic pressure: the pressure when the ventricles of the heart squeeze and propel blood into the arteries.
  • Diastolic pressure: the pressure measured between heartbeats when the ventricles relax. This is the time that the heart receives its oxygenated blood.

A systolic blood pressure reading of 120 mmHg and a diastolic blood pressure of 80mmHg or 120/80 are considered normal. A person with a reading of 90/60 mmHg or lower is considered to have hypotension or low blood pressure.

People who have orthostatic hypotension often experience a drop in blood pressure of about 20/10 mmHg within 3 minutes of standing.

Low blood pressure does not usually require treatment. If a person experiences regular symptoms of orthostatic hypotension, however, they should see a doctor.

Orthostatic hypotension is common among people who are 65 or older because the body’s ability to react to drops in blood pressure can slow down as a person ages.

Figures cited in research by the National Center for Biotechnology Information estimate that orthostatic hypotension is prevalent in around 18 percent of men and women aged 65 or older in the United States.

The same study noted that cases of orthostatic hypotension among the elderly account for 35 percent of hospital admissions in the U.S.


Signs and Symptoms of Orthostatic Hypotension

The most common symptoms of orthostatic hypotension are dizziness and lightheadedness upon standing up. The symptoms will usually go away when sitting or lying down.

Other common symptoms include:

Less common symptoms include:

  • Chest pain.
  • Fainting.
  • Neck and shoulder pain.


Causes of Orthostatic Hypotension

Loss of fluid within the blood vessels is the most common cause of symptoms linked to orthostatic hypotension. This could be due to dehydration brought about by diarrhea, vomiting, and the use of medication, such as diuretics or water pills. This medication helps the body get rid of excess water and salt through urine.

Loss of blood, anemia, and other conditions that result in a lower red blood count are also likely causes. When there are fewer red blood cells available to carry oxygen in the bloodstream, dizziness and light-headedness may occur.

Some medications, such as beta-blockers and antidepressants, can also trigger symptoms linked to orthostatic hypotension. Working or exercising in hot weather or being bedridden for a prolonged period can also lead to these symptoms.

Parkison’s Disease pregnancy, and heart conditions such as irregular heart rhythms and valve disease are also known to cause symptoms connected to orthostatic hypotension.

Risk Factors of Orthostatic Hypotension

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:

  • Alcohol drinking
  • Antidepressants
  • Cardiac pump failure 
  • Chemotherapy drugs
  • Dehydration
  • Diabetes
  • Guillain-Barre Syndrome
  • Hypovolemia (low blood plasma)
  • Some antipsychotic drugs
  • Spinal cord problems
  • Underlying conditions that cause the malfunction of the autonomic nervous system (such as Parkinson’s disease)
  • Venous pooling (when gravity causes blood to pool in the stomach and legs) 
  • Vasodilator drugs (such as those that treat high blood pressure and Parkinson’s disease)

Certain risk factors can increase the possibility that you may experience orthostatic hypotension. Some individuals who are more at risk include:

  • Individuals who have been on bed rest
  • Older people (age 65 and older), especially those who spend a lot of time lying down
  • Teenagers (because of how fast they are growing in a shorter period of time)
  • Women who have recently given birth

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.

Diagnosis of Orthostatic Hypotension

If your doctor suspects that you have orthostatic hypotension, they will check your blood pressure while you’re sitting, lying down, and standing. If needed, the doctor will then conduct tests to find out if an underlying condition or illness is causing the symptoms.

For example, if a particular medication is causing the blood pressure to drop, the doctor may adjust the dosage or recommend a switch to another drug.

A head-up tilt table test will look at how a person’s blood pressure reacts to changes in their body’s position. During this test, a person lies on a table that is slowly tilted upward.

Blood tests can show whether someone has low blood sugar or a low number of red blood cells, which are both signs of low blood pressure.

An electrocardiogram (ECG or EKG), which monitors the heart’s electrical signals, can uncover irregularities in heart rhythm and problems with blood and oxygen supply to the heart.

An ultrasound of the heart, or echocardiogram, assesses the heart valves using sound waves and could uncover underlying disorders.

A stress test can be conducted where a doctor monitors the heart while the person is exercising or after being given medication.

Treatment of Orthostatic Hypotension

There are several ways of managing or preventing orthostatic hypotension, most of which do not involve the use of medication.

  • Avoid strenuous activity during hot weather.
  • Compression stockings can promote circulation and help prevent fluid from pooling in the legs.
  • Keep hydrated by drinking plenty of fluids. Fluids lost from diarrhea or vomiting should be replaced immediately. Avoid or limit alcohol intake because alcohol can worsen orthostatic hypotension.
  • Sleep with the head of your bed slightly elevated.
  • Use more salt in meals: However, consult a doctor first as too much salt in the diet can increase blood pressure.
  • When getting out of bed, sit on the edge of the bed for a minute before standing.

Severe cases of orthostatic hypotension can be treated with drugs to raise blood pressure.


Complications of Orthostatic Hypotension

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, stroke and other cardiovascular conditions.

The symptoms could also mask more serious conditions. Living with blood pressure that frequently drops and rises can increase the risk of cardiovascular diseases, such as heart failure and heart rhythm problems.

The sudden drops in blood pressure caused by orthostatic hypotension are a risk factor for strokes strokes because of the reduced blood supply to the brain.

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