Postural or Orthostatic Hypotension Overview

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 three 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 to ten minutes later. This is called delayed orthostatic hypotension, and it is uncommon.

Causes

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
• Postural Orthostatic Tachycardia Syndrome (POTS)
• Vasovagal syncope
• Postprandial hypotension

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

Treatment

Since the specific issue causing the problem varies 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, you're likely to have the best outcomes if you see your healthcare 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