Orthostatic Hypotension (Postural Hypotension)

If you’re ever felt sudden dizziness, lightheadedness, or even fainted when standing up suddenly, you may have experienced a sudden, drastic drop in blood pressure called orthostatic hypotension, or postural hypotension.

This mild, low-blood pressure condition shouldn’t last for more than a few minutes.

But frequently feeling lightheaded or dizzy shouldn’t be ignored.

Orthostatic hypotension symptoms can point to serious, underlying health issues, like a heart condition.

Talk to your doctor to get a proper diagnosis and for help managing orthostatic hypotension. 

In this article, I’ll explain more about the symptoms and causes of orthostatic hypotension, as well as risks and dangers of this condition.

I’ll also tell you when to talk to your doctor about orthostatic hypotension.

What is Orthostatic Hypotension?

“Orthostasis” means “to stand up.” And “hypotension” means low blood pressure.

So when you stand up from sitting or lying down and experience low blood pressure, that’s orthostatic hypotension.

Blood pressure is a measure of your blood pressing against the walls of your arteries as it is pumped by your heart through your body.

This level of pressure is measured in millimeters of mercury (mmHg), and is usually shown as two numbers—such as 120/80.

The first number is systolic pressure, measuring your blood pressure when your heart beats.

The second number, diastolic pressure, represents the pressure between beats.

When the measurement falls below 90/60 mmHg, blood pressure is low.

Many patients with orthostatic hypotension experience a drop of 20 mmHg in systolic pressure and 10 mmHg in diastolic pressure within a few minutes of standing up. 

There is typically a reason for your orthostatic hypotension, like dehydration or feeling overly tired.

If the condition is chronic, however, there may be more serious underlying conditions, like heart problems. 

Symptoms of Orthostatic Hypotension

The main symptom of orthostatic hypotension is feeling dizzy or lightheaded after rising from the downright position.

Fainting is another common symptom.

These symptoms usually do not last for more than a few minutes. 

Other symptoms include: 

• Nausea 
• Feeling weakened or fatigued 
• Blurry vision
• Headaches 
• Confusion 
• Difficulty concentrating 
• Heart palpitations 
• Sweating profusely or feeling hot 
• Shortness of breath 
• Chest pain
• Neck or shoulder pain 

Causes of Orthostatic Hypotension

Normally, when you move from a sitting or lying position to standing, your blood pressure and heart rate adjust quickly due to your nervous system, muscles, and cardiovascular systems all working together.

One thing that happens is that blood that’s pooled in your legs when you’re sitting or lying down—300-800 mL of it—is rapidly squeezed back up to your heart.

If your systems don’t all work together, the amount of blood returned to your heart from your legs can be reduced when you stand, or your heart might not beat more rapidly to bring the blood back through, resulting in a case of orthostatic hypotension.

Some patients experience their symptoms more severely in the morning, when their blood pressure is lowest. 

Other common causes of orthostatic hypotension include: 

Dehydration

If you are not drinking enough fluids, or have a fever or diarrhea, you can experience dehydration.

Dehydration decreases the volume of blood in the body.

Over-exercising and excessive sweating is another common cause of dehydration, causing low blood pressure. 

Nervous system disorders

When orthostatic hypotension happens often, it is chronic.

Chronic orthostatic hypotension can be caused by dysfunction in your autonomic nervous system, the part of your nervous system that controls involuntary bodily functions, including blood pressure.

This form of orthostatic hypotension is called the neurogenic form.

Parkinson’s disease, Lewy body dementia, multiple system atrophy, diabetes, and other nervous system disorders can all be related to orthostatic hypotension. 

Heart problems

When orthostatic hypotension is not caused by your nervous system, it’s called “non-neurogenic.”

Heart disease can be one of non-neurogenic orthostatic hypotension, as can be some medications used for people with heart disease risk factors—blood pressure-lowering medications and diuretics, like water pills, can cause these drops in blood pressure.

Endocrine problems

Endocrine problems, also known as thyroid conditions, can contribute to orthostatic hypotension and low blood pressure. 

People with low blood sugar or diabetes might experience damage to their nerves.

This nerve damage can interfere with signals sent to the brain, and the body’s attempt to regulate low blood pressure. 

Risk Factors

Age

Orthostatic hypotension commonly occurs in people 65 and older.

The cells (baroreceptors) near your heart that regulate blood pressure can slow down with age.

Over time, your heart struggles to work at a faster pace to compensate for the low blood pressure. 

Medications

There are many common medications that list orthostatic hypotension as a possible side effect, including: 

• Diuretics that treat heart disease or high blood pressure 
• Alpha blockers, including doxazosin (Cardura)
• Beta blockers, including atenolol (Tenormin) and bisoprolol (Zebeta)
• Angiotensin-converting enzyme (ACE) inhibitors
• Muscle relaxants
• Antidepressants, including imipramine (Tofranil) 
• Erectile dysfunction medications, including sildenafil (Viagra)
• Parkinson’s disease medications, including droxidopa (Northera)

Diseases

Some heart valve diseases or nervous system disorders, like Parkison’s disease, can lead to low blood pressure or orthostatic hypotension.

Some other common diseases that cause orthostatic hypotension include: 

• Diabetes 
• Endocrine diseases 
• Nerve damage 
• Anemia 
• Vitamin B12 deficiency 

Heat exposure

Many patients report experiencing orthostatic hypotension while under hot temperatures. 

Excessive sweating, dehydration, or even taking a very hot shower has been known to trigger orthostatic hypotension.  

Recent meals

Some older people experience low blood pressure after eating.

The heart sends blood to the digestive tract a couple of hours after eating.

If the heart is unable to regulate the blood pressure throughout the rest of the body, blood pressure levels drop.

Eat smaller, more frequent meals may help.

Bed rest

Too much bed rest can trigger orthostatic hypotension.

As you try to stand up, your body isn’t able to stabilize itself and return blood pressure levels to normal.

Flexing and unflexing your ankles for a few minutes before standing up may help, as can getting up slowly.

Pregnancy

The circulatory system expands rapidly during the first two trimesters of pregnancy.

The circulatory expansion causes the body’s blood pressure to drop, which can lead to orthostatic hypotension.

Blood pressure should return to normal after giving birth.

Alcohol

Drinking alcohol can cause dehydration, which can trigger orthostatic hypotension. 

Dangers of Orthostatic Hypotension

In severe cases or orthostatic hypotension, the body can go into shock or organ failure if blood pressure stays low for too long. 

There are a few other dangers to keep in mind with this condition. 

Falls

Each year, as many as 3 million older people visit the emergency room or hospital due to a fall.

Due to the dizziness associated with orthostatic hypotension, falls can happen when blood pressure drops.

Fainting is also a common occurrence.

Falls can cause concussions, bone fractures, or other serious bodily injuries. 

Stroke

Orthostatic hypotension may be predictive of stroke.

If you experience orthostatic hypotension and have other risk factors for stroke, including high blood pressure, tell your doctor.

Heart problems

Orthostatic hypotension is associated with increased risk of cardiovascular complications such as chest pain, heart failure, and heart attack.

When to See a Medical Provider for Orthostatic Hypotension

If you have chronic symptoms of orthostatic hypotension, talk to your healthcare provider.

Chronic symptoms can signal more serious problems, like a heart condition.

Keep a record of your symptoms, so you can make a plan with your doctor to help regulate and stabilize your blood pressure. 

Seek medical attention immediately if you have chest pain, or fall or faint after standing up.

See a doctor if you think you have a head injury, concussion, or bodily injury after falling.

If you think you show signs of shock, see a doctor. Signs of shock include cold, sweaty skin, a blue skin tone, weak pulse and rapid breathing.

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