Orthostatic Hypotension

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KEY POINTS

• Orthostatic hypotension is a drop in blood pressure that happens right after you stand after sitting or lying down.
• Orthostatic hypotension can be treated by wearing support stockings or an abdominal binder, raising the head of your bed, or exercising. Sometimes medicine is used.
• Make sure to stand up slowly, especially if you’ve been sitting or lying down for a long time.

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What is orthostatic hypotension?

Orthostatic hypotension is a drop in blood pressure that can happen right after you stand up after sitting or lying down. It is also called postural hypertension.

What is the cause?

When you stand up, the force of gravity pulls your blood downward and the blood tends to settle in your legs. Blood pressure can start to fall, so there is less blood going to your brain. If your body is not able to increase blood flow and narrow blood vessels fast enough when you change your position, your blood pressure can get too low. You are more likely to have this problem if:

• You are over age 65.
• You take medicines such as diuretics, nitrates, blood pressure medicines, or antidepressants.
• You have a heart valve problem or a disease such as diabetes that damages nerves.
• You are dehydrated (lost too much fluid from your body).

What are the symptoms?

Symptoms happen within a few minutes after you stand up, and may include:

• Feeling lightheaded or dizzy
• Sweating
• Blurred vision
• Weakness
• Fainting (passing out)

Symptoms usually last just a few minutes.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your provider may check your blood pressure when you are lying down, sitting, and standing up. You may have blood tests and X-rays.

How is it treated?

If you are having this problem because of a medicine you are taking, your healthcare provider may change the medicine or your dosage. Your provider may also recommend that you:

• Wear support stockings, which squeeze your legs and help prevent pooling of blood. Ask your healthcare provider which stockings to buy and how to use them.
• Raise the head of your bed 6 to 8 inches by putting the frame on wood blocks. If you cannot raise the frame of the bed, try placing a foam wedge under the head of your mattress.
• Make sure that you drink plenty of liquids and get enough salt in your diet.
• Get regular, moderate exercise as recommended by your healthcare provider.
• See a physical therapist to learn if there are exercises you can do to prevent low blood pressure.
• Put on an elastic belly wrap (abdominal binder) before you get out of bed and remove it before you lie down.

If these treatments do not help, your provider may prescribe medicine to raise your blood pressure.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• When you stand up, do it slowly. If you have been lying down, sit for awhile before standing. This allows your blood pressure to adjust.
• Tell your healthcare provider if you think that a medicine you are taking may be making your symptoms worse. Check with your provider about nonprescription medicines and supplements before you start taking them.
• Drink 2 eight-ounce cups of cold water 30 minutes before you get up or if you know you will be standing for a long time, such as when shopping.
• Avoid eating large meals and drinking alcohol. It may also help to avoid exercising after meals.
• Bend your knees a little instead of locking them if you have to stand for long periods of time.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.