What is Orthostatic Hypotension? Symptoms, Causes, & Treatment

Orthostatic hypotension is when your blood pressure drops significantly after you stand up from sitting or lying down. This happens because your body temporarily struggles to pump enough blood to your brain and other organs when you change positions.

You might know this feeling as getting dizzy or lightheaded when you stand up too quickly. While it can be startling, understanding what's happening in your body can help you manage it better and know when to seek medical care.

What is orthostatic hypotension?

Orthostatic hypotension occurs when your blood pressure falls by at least 20 points systolic or 10 points diastolic within three minutes of standing. Your systolic pressure is the top number in your blood pressure reading, while diastolic is the bottom number.

When you stand up, gravity pulls blood toward your legs and away from your brain. Normally, your nervous system quickly adjusts by making your heart beat faster and tightening blood vessels. But sometimes this process doesn't work smoothly, leaving you feeling woozy or unsteady.

This condition affects people of all ages but becomes more common as you get older. Your body's ability to regulate blood pressure can naturally decline with age, making these episodes more frequent.

What are the symptoms of orthostatic hypotension?

The symptoms typically appear within moments of standing up and can range from mild to quite noticeable. Your body is essentially telling you that your brain isn't getting enough blood flow in that moment.

Common symptoms you might experience include:

• Dizziness or lightheadedness when standing
• Feeling faint or like you might pass out
• Blurred or dimmed vision
• Weakness or fatigue
• Confusion or difficulty concentrating
• Nausea

More serious symptoms can occur in some cases, though they're less common. These might include actually fainting, chest pain, or headaches. If you experience fainting episodes, it's important to speak with your doctor since falls can lead to injuries.

What causes orthostatic hypotension?

Several factors can interfere with your body's ability to maintain steady blood pressure when you stand. Understanding these causes can help you and your doctor identify what might be contributing to your symptoms.

The most common causes include:

• Dehydration from not drinking enough fluids, fever, or excessive sweating
• Medications like blood pressure drugs, antidepressants, or diuretics
• Prolonged bed rest or inactivity
• Heart problems that affect pumping ability
• Nervous system disorders
• Endocrine conditions like diabetes or thyroid problems

Sometimes the cause is temporary and easily fixed, like dehydration after a stomach bug. Other times, it might be related to a medication that can be adjusted or an underlying condition that needs treatment.

In some cases, doctors can't identify a specific underlying cause. This is called primary orthostatic hypotension, and it often relates to how your nervous system regulates blood pressure as you age.

When to see a doctor for orthostatic hypotension?

You should contact your doctor if you experience frequent episodes of dizziness or lightheadedness when standing. While occasional mild symptoms might not be concerning, regular occurrences deserve medical attention.

Seek medical care promptly if you experience fainting episodes, severe dizziness that interferes with daily activities, or symptoms that worsen over time. These could indicate an underlying condition that needs treatment.

Call for emergency help if you have chest pain, difficulty breathing, or severe headaches along with your symptoms. These combinations could signal more serious cardiovascular or neurological issues that require immediate attention.

What are the risk factors for orthostatic hypotension?

Certain factors make you more likely to develop this condition. Age is the biggest risk factor since your body's blood pressure regulation naturally becomes less efficient over time.

Other risk factors include:

• Being over 65 years old
• Taking multiple medications, especially blood pressure or heart medications
• Having diabetes or other endocrine disorders
• Heart disease or heart failure
• Parkinson's disease or other neurological conditions
• Prolonged bed rest or immobility
• Pregnancy, especially in the second and third trimesters

Having one or more risk factors doesn't mean you'll definitely develop orthostatic hypotension. However, being aware of these factors can help you and your doctor watch for symptoms and take preventive steps.

What are the possible complications of orthostatic hypotension?

The main concern with orthostatic hypotension is the risk of falls and injuries. When you feel dizzy or faint, you might lose your balance and fall, potentially leading to fractures or head injuries.

Falls are particularly dangerous for older adults, who may have more fragile bones and take longer to recover from injuries. Even a minor fall can sometimes lead to serious complications like hip fractures or concussions.

In rare cases, severe episodes might cause you to lose consciousness completely. This can be dangerous if it happens while you're driving, operating machinery, or in other potentially hazardous situations.

Some people develop a fear of standing or moving around, which can lead to reduced activity levels and physical deconditioning. This creates a cycle where inactivity actually makes the condition worse over time.

How is orthostatic hypotension diagnosed?

Your doctor will likely start by taking your blood pressure while you're lying down, then again after you stand up. They'll measure it at one and three minutes after standing to see how much it drops.

A tilt table test might be recommended if your symptoms are severe or if the standard testing doesn't capture your episodes. During this test, you lie on a table that slowly tilts upward while your blood pressure and heart rate are monitored.

Your doctor will also review your medications, medical history, and symptoms to identify potential causes. Blood tests might be ordered to check for conditions like diabetes, anemia, or thyroid problems that could contribute to your symptoms.

What is the treatment for orthostatic hypotension?

Treatment focuses on addressing the underlying cause when possible and managing symptoms to prevent falls and improve your quality of life. The approach depends on what's causing your condition and how severe your symptoms are.

If medications are contributing to your symptoms, your doctor might adjust dosages or switch to different drugs. Never stop taking prescribed medications without talking to your doctor first, as this could be dangerous for other health conditions.

For cases related to dehydration or low blood volume, increasing fluid and salt intake might help. Your doctor might recommend drinking more water throughout the day or adding a bit more salt to your diet.

In some situations, medications specifically for orthostatic hypotension might be prescribed. These drugs help your body retain fluid or tighten blood vessels to maintain better blood pressure when standing.

How to manage orthostatic hypotension at home?

Simple lifestyle changes can often make a significant difference in managing your symptoms. The key is to help your body adjust more gradually to position changes and maintain adequate blood volume.

When getting up, move slowly and in stages. Sit on the edge of your bed for a minute before standing, then stand still for a moment before walking. This gives your circulatory system time to adjust.

Stay well hydrated by drinking plenty of fluids throughout the day. Water is best, but other non-alcoholic beverages count too. Avoid large amounts of alcohol, which can worsen dehydration and symptoms.

Compression stockings can help prevent blood from pooling in your legs. These special stockings apply gentle pressure to encourage blood flow back toward your heart and brain.

Elevating the head of your bed by 4-6 inches can help reduce morning symptoms. This position helps your body maintain better blood pressure regulation during sleep.

How should you prepare for your doctor appointment?

Keep a symptom diary for a week or two before your appointment. Note when symptoms occur, what you were doing, and how severe they felt. This information helps your doctor understand patterns and triggers.

Bring a complete list of all medications you take, including prescription drugs, over-the-counter medications, and supplements. Include dosages and when you take them, as timing can affect blood pressure.

Write down questions you want to ask your doctor. You might forget important concerns during the appointment, so having them written down ensures you get the information you need.

Consider bringing a family member or friend who can help you remember information discussed during the visit. They might also provide helpful observations about your symptoms that you haven't noticed.

What's the key takeaway about orthostatic hypotension?

Orthostatic hypotension is a manageable condition that affects many people, especially as they age. While the symptoms can be concerning, understanding what's happening helps you take appropriate steps to stay safe.

The most important thing is recognizing your symptoms and taking precautions to prevent falls. Simple changes like moving slowly when standing up and staying hydrated can make a real difference in how you feel.

Work with your healthcare provider to identify any underlying causes and develop a treatment plan that works for you. With proper management, most people with orthostatic hypotension can continue their normal activities safely.