Why Do I Get Dizzy When I Stand Up?

Orthostatic hypotension is a condition that can cause you to feel dizzy when standing up after sitting or lying down for a long time.

Dizziness can be mild and only last a minute or two, but if it happens frequently, it could signal an underlying issue.

This article will describe symptoms and causes of orthostatic hypotension and when to see a healthcare provider about this condition.

Symptoms

Orthostatic hypotension produces low blood pressure when upright, which can result in a variety of different symptoms depending on the severity of the drop in blood pressure. These include:

• Dizziness 
• Light-headedness
• Nausea
• Weakness
• Sweating
• Hearing and visual disturbances
• Neck and shoulder pain
• Altered mental state
• Loss of consciousness

Causes and Risk Factors

Orthostatic hypotension, or low blood pressure with upright posture, is defined as a sustained decrease in systolic blood pressure (the top number) by 20 mmHg (millimeters of mercury) or more, or a decrease in diastolic blood pressure (the bottom number) by 10 mmHg or more. If systolic blood pressure drops less than 20 mmHg when standing but is overall less than 90 mmHg, orthostatic hypotension is also present.

With orthostatic hypotension, damage to nerves of the autonomic nervous system affects this natural response of the blood vessels and heart to alter blood pressure with a change in position. 

Risk factors for developing orthostatic hypotension can be divided into three different categories, which include drug-induced, volume depletion, and neurogenic.

Drug‐Induced Factors

Specific medications can cause orthostatic hypotension due to side effects that may decrease blood pressure. Medications that can cause orthostatic hypotension include:

• Antihypertensive drugs used to treat high blood pressure, including alpha-blockers, vasodilators, or medications that dilate (open) blood vessels, and diuretics (water pills)
• Vasoactive drugs or medications that increase or decrease blood pressure
• Tricyclic antidepressants
• Parkinson’s disease drugs

Depletion of Intravascular Volume

Certain conditions that lower the volume of blood plasma, which lowers blood pressure, can also cause orthostatic hypotension. These include:

• Dehydration
• Vomiting
• Diuretic medication use
• Bleeding 
• Heart failure
• Chronic venous insufficiency (when the veins in your leg don't allow blood to flow back to your heart)

Neurogenic Factors

Neurogenic causes of orthostatic hypotension are conditions that impair the function of the autonomic nervous system. These causes can be subdivided into primary causes, due to degenerative neurological diseases, or secondary causes, due to non‐neurological chronic disorders.

Primary

• Parkinson’s disease (a progressive neurological disorder affecting movement)
• Lewy body disease (a form of dementia)
• Guillain-Barre syndrome (an autoimmune disorder that leads to muscle loss)
• Pure autonomic failure (a disorder of the autonomic nervous system)
• Multiple system atrophy (a rare neurological disorder)
• Familial dysautonomia (a rare genetic condition that affects specific nerve cells)

Secondary

• Diabetes mellitus
• Chronic kidney disease
• Essential (primary) hypertension (high blood pressure not caused by another condition)
• Autoimmune diseases
• Alcoholism
• Endocrine disorders
• Amyloidosis (a buildup of amyloid proteins)
• Paraneoplastic syndrome (rare disorders that are caused by an abnormal immune system response to a cancerous tumor)
• Multiple myeloma (a rare type of blood cancer)
• Cerebrovascular disease (a disease of the blood vessels in the brain)
• HIV (human immunodeficiency virus) infection
• B12 deficiency
• Hepatitis C infection 

Treatment and Prevention

If medication is causing orthostatic hypotension as a side effect, your healthcare provider may suggest discontinuing the medication, lowering the dose, or replacing it with a different type.

Certain medications may also be prescribed to help reduce symptoms of orthostatic hypotension, primarily midodrine (constricts blood vessels) and fludrocortisone (increases blood volume through the retention of salt and water).

Other lifestyle modifications that can be used to treat orthostatic hypotension include:

• Avoiding prolonged bed rest 
• Avoiding standing up quickly
• Staying hydrated throughout the day
• Avoiding large meals
• Avoiding alcohol consumption
• Avoiding hot and humid environments
• Wearing compression stockings to help with blood flow
• Regularly exercising to improve the function of the heart and blood vessels
• Sleeping with the head of the bed elevated

When to See a Healthcare Provider

Orthostatic hypotension can be a serious condition that can decrease blood flow to your brain. You should see your healthcare provider if you regularly feel dizzy, light-headed, weak, or nauseated when you stand up. If you ever experience a loss of consciousness upon standing up, you should seek immediate medical attention as this is a sign of an emergency.

Summary 

Orthostatic hypotension is a condition characterized by a drop in blood pressure that makes you feel dizzy when standing up. Orthostatic hypotension is prevalent in older adults and those with multiple comorbidities and can cause symptoms like dizziness, light-headedness, nausea, weakness, and altered mental status.

Treatment for orthostatic hypotension will vary based on the underlying cause but may include changing medications to minimize side effects, trying new medications to manage symptoms, and lifestyle changes like increasing water intake, wearing compression stockings, avoiding hot and humid environments, and sleeping with the head of your bed elevated.

A Word From Verywell 

Orthostatic hypotension is often the result of side effects from medication or chronic inflammatory conditions. If you are having symptoms of orthostatic hypotension, it is important that you undergo a thorough medical examination with your healthcare provider to help determine any underlying causes. Orthostatic hypotension can be a serious condition that requires proper diagnosis and treatment.