What Is Postural or Orthostatic Hypotension?

When Low Blood Pressure Causes Health Concerns

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Patients with orthostatic hypotension, also called postural hypotension, may feel lightheaded (or even fall or faint) when they stand up after sitting or laying down for a period of time. This debilitating illness is relatively common and primarily affects older adults. The diagnosis of orthostatic hypotension requires a decrease in blood pressure of 20mmHg systolic, or 10mmHg diastolic, within five minutes of rising from a seated or lying position.

While most people with orthostatic hypotension experience symptoms immediately upon changes in body position, a small number of patients might not have symptoms until five to10 minutes later. This is called delayed orthostatic hypotension, and it is uncommon.

What Causes Orthostatic Hypotension?

Orthostatic hypotension can be caused by another health condition or even some medications. Neurologic conditions are the most common cause of orthostatic hypotension, including:

  • Parkinson's disease
  • Diabetic nerve damage
  • Lewy body disease, one of the most common causes of dementia in older adults

But neurologic conditions are not the only cause. In fact, several non-neurogenic causes of the condition include:

  • Heart attack
  • Aortic stenosis
  • Vasodilation

Drugs that can cause orthostatic hypotension include:

  • Diuretics
  • Antihypertensive drugs
  • Tricyclic antidepressants 

How is Orthostatic Hypotension Treated?

Since the specific issue causing the problem vary from person to person, there is no single treatment for orthostatic hypotension.

Sometimes the solution is as simple as discontinuing a certain medication you've been taking, or increasing your fluid intake in order to replenish blood volume.

Other treatment options include:

  • Patient education about how to carry and adjust their body positions
  • Exercise, for cases caused by a weakened cardiovascular system
  • Medical treatment with agents like fludrocortisone, phenylephrine, or midodrine to adjust both the blood pressure and the function of the nervous system

When to See a Doctor

Even a single episode of fainting after standing up is sufficient reason to schedule a visit to the doctor. Since the symptoms of orthostatic hypotension tend to worsen over time, your likely to have the best outcomes if you see your health care provider as soon as possible.

In the absence of symptoms that may indicate a more immediate problem like a heart attack or stroke, the doctor will likely do a series of tests that may include

  • Blood work
  • A physical exam
  • A tilt test

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Sources:

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van Lieshout, et al. Physical Manoeuvres for Combating Orthostatic Dizziness in Autonomic Failure. Lancet 1992; 339:897.

Young, TM, Mathias, CJ. The Effects of Water Ingestion on Orthostatic Hypotension in Two Groups of Chronic Autonomic Failure: Multiple System Atrophy and Pure Autonomic Failure. Journal of Neurology and Neurosurgical Psychiatry 2004; 75:1737.

Singer, W, et al. Pyridostigmine Treatment Trial in Neurogenic Orthostatic Hypotension. Arch Neurol 2006; 63:513.

Lee T, Donegan C, Moore A. Combined hypertension and orthostatic hypotension in older patients: a treatment dilemma for clinicians. Expert Reviews of Cardiovascular Therapy. 2005; 433-40.

Sandroni P, et al. Pyridostigmine for treatment of neurogenic orthostatic hypotension - A follow-up survey study. Clinical Autonomic Research. 2005; 51-3.

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