Orthostatic hypotension, also known as postural hypotension, occurs
when a person's blood pressure falls when suddenly standing up from a
lying or sitting position. It is defined as a fall in systolic
blood pressure of at least 20 mm Hg or diastolic blood pressure
of at least 10 mm Hg when a person assumes a standing position.
It occurs predominantly by delayed constriction of the lower body
blood vessels, which is normally required to maintain an adequate
blood pressure when changing position to standing. As a result, blood
pools in the blood vessels of the legs for a longer period and less is
returned to the heart, thereby leading to a reduced cardiac output.
Mild orthostatic hypotension is common and can occur briefly in
anyone, although it is prevalent in particular among the elderly and
those with known low blood pressure. Severe drops in blood pressure
can lead to fainting, with a possibility of injury.
There are numerous possible causes for orthostatic hypotension, such
as certain medications (e.g. alpha blockers), autonomic neuropathy,
decreased blood volume, and age-related blood vessel stiffness.
Apart from addressing the underlying cause, orthostatic hypotension
may be treated with a recommendation to increase salt and water intake
(to increase the blood volume), wearing compression stockings, and
sometimes medication (fludrocortisone, midodrine or others).
1 Signs and symptoms
2.4 Other factors
4.1 Non-pharmacological management
4.2 Pharmacological management
6 See also
8 External links
Signs and symptoms
Orthostatic hypotension is characterised by symptoms that occur after
standing (from lying or sitting), particularly when this is done
rapidly. Many report lightheadedness (a feeling that one might be
about to faint), sometimes severe. Generalized weakness or tiredness
may also occur. Some also report difficulty concentrating, blurred
vision, tremulousness, vertigo, anxiety, palpitations (awareness of
the heartbeat), feeling sweaty or clammy, and sometimes nausea. A
person may look pale.
Orthostatic hypotension is caused primarily by gravity-induced blood
pooling in the lower extremities, which in turn compromises venous
return, resulting in decreased cardiac output and subsequent lowering
of arterial pressure. For example, changing from a lying position to
standing loses about 700 ml of blood from the thorax, with a decrease
in systolic and diastolic blood pressures. The overall effect is an
insufficient blood perfusion in the upper part of the body.[citation
Still, the blood pressure does not normally fall very much, because it
immediately triggers a vasoconstriction (baroreceptor reflex),
pressing the blood up into the body again. (Often, this mechanism is
exaggerated and is why diastolic blood pressure is a bit higher when a
person is standing up, compared to a person in the horizontal
position.) Therefore, a secondary factor that causes a greater than
normal fall in blood pressure is often required. Such factors include
low blood volume, diseases, and medications.
Orthostatic hypotension may be caused by low blood volume, bleeding,
the excessive use of diuretics, vasodilators, or other types of drugs,
dehydration, or prolonged bed rest(immobility); as well as occurring
in people with anemia.
The disorder may be associated with Addison's disease, atherosclerosis
(build-up of fatty deposits in the arteries), diabetes,
pheochromocytoma, porphyria, and certain neurological disorders,
including multiple system atrophy and other forms of dysautonomia. It
is also associated with
Ehlers–Danlos syndrome and anorexia nervosa.
It is also present in many patients with
Parkinson's disease resulting
from sympathetic denervation of the heart or as a side-effect of
dopaminomimetic therapy. This rarely leads to fainting unless the
person has developed true autonomic failure or has an unrelated heart
Another disease, dopamine beta hydroxylase deficiency, also thought to
be underdiagnosed, causes loss of sympathetic noradrenergic function
and is characterized by a low or extremely low levels of
norepinephrine, but an excess of dopamine.
Quadriplegics and paraplegics also might experience these symptoms due
to multiple systems' inability to maintain a normal blood pressure and
blood flow to the upper part of the body.
Orthostatic hypotension can be a side-effect of certain
antidepressants, such as tricyclics or monoamine oxidase inhibitors
(MAOIs). Marijuana and tetrahydrocannabinol can on occasion produce
marked orthostatic hypotension. Alcohol can also potentiate
orthostatic hypotension to the point of syncope. Orthostatic
hypotension can also be a side effect of alpha-1 blockers (alpha1
adrenergic blocking agents). Alpha1 blockers inhibit vasoconstriction
normally initiated by the baroreceptor reflex upon postural change and
the subsequent drop in pressure.
Patients prone to orthostatic hypotension are the elderly, post partum
mothers, and those having been on bedrest. People suffering from
anorexia nervosa and bulimia nervosa often suffer from orthostatic
hypotension as a common side-effect. Consuming alcohol may also lead
to orthostatic hypotension due to its dehydrating effects.[citation
Orthostatic hypotension can be confirmed by measuring a person's blood
pressure after lying flat for 5 minutes, then 1 minute after standing,
and 3 minutes after standing.
Orthostatic hypotension is defined
as a fall in systolic blood pressure of at least 20 mmHg and/or in the
diastolic blood pressure of at least 10 mmHg between the supine
reading and the upright reading. In addition, the heart rate should
also be measured for both positions. A significant increase in heart
rate from supine to standing may indicate a compensatory effort by the
heart to maintain cardiac output or postural orthostatic tachycardia
syndrome (POTS). A tilt table test may also be performed.[citation
Apart from treating underlying reversible causes (e.g., stopping or
reducing certain medications), there are a number of measures that can
improve the symptoms of orthostatic hypotension and prevent episodes
of syncope. Even small increases in the blood pressure may be
sufficient to maintain blood flow to the brain on standing.
In people who do not have a diagnosis of high blood pressure, drinking
2–3 liters of fluid a day and taking 10 grams of salt can improve
symptoms, by maximizing the amount of fluid in the bloodstream.
Another strategy is keeping the head of the bed slightly elevated.
This reduces the return of fluid from the limbs to the kidneys at
night, thereby reducing nighttime urine production and maintaining
fluid in the circulation. Various measures can be used to improve
the return of blood to the heart: the wearing of compression stockings
and exercises ("physical counterpressure manoeuvres" or PCMs) that can
be undertaken just before standing up (e.g., leg crossing and
The medication midodrine can benefit people with orthostatic
hypotension, The main side-effect is piloerection ("goose
Fludrocortisone is also used, although based on more
A number of other measures have slight evidence to support their use
indomethacin, fluoxetine, dopamine antagonists, metoclopramide,
domperidone, monoamine oxidase inhibitors with tyramine (can produce
severe hypertension), oxilofrine, potassium chloride, and
Orthostatic hypotension may cause accidental falls. It is also
linked to an increased risk of cardiovascular disease, heart failure,
and stroke. There is also observational data suggesting that
orthostatic hypotension in middle age increases the risk of eventual
dementia and reduced cognitive function.
Postural orthostatic tachycardia syndrome
^ "Orthostatic hypotension" at Dorland's Medical Dictionary
Hypotension Information Page National Institute of
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Hypotension and other Autonomic Failure
Syndromes at eMedicine
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V · T · D
Orthostatic hypotension at Curlie (based on DMOZ)
Diseases of the autonomic nervous system (G90, 337)
IV/Congenital insensitivity to pain with anhidrosis
Postural orthostatic tachycardia syndrome
Multiple system atrophy
Pure autonomic failure
Cardiovascular disease (vessels) (I70–I99, 440–456)
Peripheral artery disease
Critical limb ischemia
Carotid artery stenosis
Renal artery stenosis
Aortoiliac occlusive disease
Aneurysm / dissection /
torso: Aortic aneurysm
Abdominal aortic aneurysm
Thoracic aortic aneurysm
Aneurysm of sinus of Valsalva
Coronary artery aneurysm
head / neck
Intracranial berry aneurysm
Carotid artery dissection
Vertebral artery dissection
Familial aortic dissection
Hereditary hemorrhagic telangiectasia
Venous thrombosis /
primarily lower limb
Deep vein thrombosis
Hepatic veno-occlusive disease
Portal vein thrombosis
Renal vein thrombosis
upper limb / torso
Cerebral venous sinus thrombosis
Chronic venous insufficiency
Chronic cerebrospinal venous insufficiency
Superior vena cava syndrome
Inferior vena cava syndrome
Arteries or veins
Hypertensive heart disease
White coat hypertension