Patient education: Orthostatic hypotension (The Basics)

What is orthostatic hypotension? — 

This is a drop in blood pressure that can happen to some people when they stand up. It can make you feel dizzy or lightheaded. It can even make you pass out. Orthostatic hypotension is also called "postural hypotension."

What are the symptoms of orthostatic hypotension? — 

The symptoms all happen when you stand up after sitting or lying down. They can include:

●Feeling lightheaded or dizzy

●Blurry or dim vision

●Weakness

●Fainting or passing out

What can cause orthostatic hypotension? — 

There are many causes. It can happen if:

●There is not enough fluid in your blood vessels – This can happen if you lose a lot of blood or if you are dehydrated. You can get dehydrated if you:

•Do not drink enough fluids

•Have severe diarrhea or vomiting

•Sweat a lot (for example, during exercise)

●Your heart doesn't pump out enough blood.

●The nerves and hormones in your body that control the blood vessels are not working properly.

●You take certain medicines that can cause orthostatic hypotension – These include those used to treat:

•High blood pressure

•Chest pain caused by heart disease (called "angina")

•Depression

In some people, orthostatic hypotension is tied to another condition, such as diabetes, nerve damage, or Parkinson disease. But people who are otherwise healthy can have orthostatic hypotension, too. Older people are more likely than younger people to have it.

Should I see a doctor or nurse? — 

Yes. If you often feel dizzy or like you might pass out when you stand up, see your doctor or nurse. If you do pass out (faint), tell your doctor.

Is there a test for orthostatic hypotension? — 

Yes. There are a few tests that can help your doctor or nurse find out if orthostatic hypotension is causing your symptoms. The simplest one is to take your blood pressure and pulse while you are sitting or lying down, and then again after you stand up.

Other tests might include:

●Blood tests to see if you have "anemia," which is when the body has too few red blood cells

●Blood tests to check if your blood has the right chemical balance and if your fluid levels are in the right range

●Tests to make sure your heart is pumping correctly

How is orthostatic hypotension treated? — 

Your doctor or nurse will start by treating the cause of your orthostatic hypotension, if possible. For example:

●If you are dehydrated, your doctor or nurse will have you drink water.

●If your symptoms are not caused by dehydration, your doctor or nurse will find out they are caused by any of your medicines. If so, they might switch you to another medicine or lower your dose.

Other treatments can help with your symptoms. These include:

●Diet changes – For example, eating more salt and drinking more water might help.

●Lifestyle changes – These can include things like changing how you sit, learning to stand up slowly, or avoiding hot and humid weather.

●Wearing compression stockings, with or without an abdominal binder – These devices apply pressure to the body and can help with certain types of orthostatic hypotension. Compression stockings are worn on the legs. The ones that go to your waist are the most helpful, but they can be hard to use. Abdominal binders are worn around the belly.

●Medicines to treat orthostatic hypotension directly – If the other treatment options do not help, your doctor can prescribe a medicine to help with your symptoms. You might need to try more than 1 medicine.

In some cases, your doctor or nurse might ask you to track your blood pressure at home. They will show you how you can do this.

What can I do on my own to feel better? — 

There are a few things you can do to reduce the problems caused by orthostatic hypotension. They are listed below. But you should try these things only after talking to your doctor or nurse.

●Stand up slowly, and give your body time to adapt. This is especially important when you get out of bed in the morning. Start by sitting up and waiting a moment. Then, swing your legs over the side of the bed and wait some more. When you do stand up, make sure you have something to hold onto in case you feel dizzy.

●Make sure you drink enough fluids, especially with meals, before exercise, and in hot weather. It might also help to drink a large glass of water first thing in the morning before getting out of bed.

●If you have symptoms after eating, it might help to make some changes to your eating habits. As examples, you can try to avoid large meals and eat meals that are low in carbohydrates. Stand up slowly when you get up from the table.

●Get regular exercise. It might be easier to exercise in a seated position, for example, using an exercise bike.

●Limit activities that could make you overheat or sweat a lot. Examples include taking hot showers and running or hiking in very hot weather. These can make orthostatic hypotension worse.

●Use extra pillows or an adjustable bed to make the head of your bed higher. This will raise your head above your heart slightly.

●Avoid drinking a lot of alcohol.

What problems should I watch for? — 

Orthostatic hypotension can lead to falls and injuries. People with orthostatic hypotension might also be at a higher risk for other health problems, including heart problems.

Call your doctor or nurse for advice if you fall and hit your head or injure yourself.

Call for emergency help right away (in the US and Canada, call 9-1-1) if you have signs of a heart attack. These might include:

●Chest pain, pressure, or discomfort

●Trouble breathing, sweating, upset stomach, or cold and clammy skin

●Pain in your arms, back, or jaw

●Pain that gets worse with activity, like walking up stairs

More on this topic

Patient education: Syncope (fainting) (The Basics)
Patient education: Low iron (The Basics)
Patient education: How to put on and take off compression stockings (The Basics)
Patient education: Using an abdominal binder (The Basics)
Patient education: Checking your blood pressure at home (The Basics)
Patient education: Preventing falls in adults (The Basics)

Patient education: Syncope (fainting) (Beyond the Basics)
Patient education: Anemia caused by low iron in adults (Beyond the Basics)