Orthostatic Hypotension (Postural Hypotension)

Low blood pressure when standing up, also known as orthostatic hypotension, happens when your blood pressure drops quickly after sitting or lying down. This can make you feel dizzy, lightheaded, or even faint.

Sometimes, this low blood pressure is only a minor problem, causing brief episodes of dizziness. But if you experience these symptoms frequently, it could indicate a more serious underlying health issue. If you often feel lightheaded when you stand up, it's important to talk to a doctor.

Short-term orthostatic hypotension often has a clear reason, like not drinking enough fluids or spending a lot of time in bed. This type is usually easy to treat. However, if the low blood pressure is a persistent problem, it's more likely a sign of another medical condition. In these cases, the treatment will depend on what is causing the problem.

Feeling dizzy or lightheaded when you stand up after sitting or lying down is a common sign of orthostatic hypotension. This feeling usually goes away within a few minutes.

Other signs of orthostatic hypotension can include:

• Feeling dizzy or lightheaded when you stand: This is the most typical symptom. It's like your head feels a little fuzzy or you're about to lose your balance.
• Blurry vision: Your vision might become unclear or less sharp.
• Weakness: You might feel shaky or unsteady, like your legs are giving out.
• Fainting (syncope): In some cases, orthostatic hypotension can lead to fainting. This is a temporary loss of consciousness.
• Confusion: You might feel disoriented or confused. This can be a less common but still important symptom.

Essentially, these symptoms all point to a problem with your body's ability to adjust blood pressure when you change positions from sitting or lying down to standing.

Feeling dizzy or lightheaded sometimes is usually nothing to worry about. It can be caused by simple things like being a little dehydrated, having low blood sugar, or getting too hot. Even standing up quickly after sitting for a while can cause these feelings. If it only happens now and then, it's probably not a problem.

However, if you often feel dizzy or lightheaded, especially when standing up, you should see a doctor. This is called orthostatic hypotension. Passing out, even for a short time, is a serious sign and needs immediate medical attention.

To help your doctor understand what's happening, keep track of when you feel dizzy or lightheaded. Note how long it lasts and what you were doing at the time. It's also important to mention if the dizziness occurs in situations where it could be dangerous, like while driving.

When you stand up from sitting or lying down, gravity pulls blood towards your legs and stomach. This makes less blood flow back to your heart, causing your blood pressure to drop.

Your body has special sensors (baroreceptors) near your heart and neck that detect this drop in blood pressure. These sensors send messages to your brain. Your brain then tells your heart to beat faster and pump harder to push more blood around, bringing your blood pressure back to normal. Your blood vessels also narrow to help increase blood pressure.

Orthostatic hypotension happens when something interferes with your body's natural response to low blood pressure when you stand up. Many things can cause this, including:

• Dehydration: Your body needs enough fluid to maintain blood volume. If you don't drink enough fluids, or lose fluids through fever, vomiting, diarrhea, heavy sweating during exercise, or other reasons, your blood volume decreases. This can lead to symptoms like weakness, dizziness, and feeling tired. Even mild dehydration can trigger orthostatic hypotension.

• Heart Problems: Some heart conditions prevent your heart from pumping blood strongly enough to compensate for the drop in blood pressure when you stand up. This includes slow heartbeats (bradycardia), problems with heart valves, heart attacks, and heart failure.

• Hormonal Issues (Endocrine Problems): Conditions affecting your thyroid, adrenal glands (like Addison's disease), and blood sugar levels (like low blood sugar or diabetes) can disrupt the signals that control blood pressure. Diabetes can also damage nerves that regulate blood pressure.

• Nervous System Disorders: Certain neurological conditions can interfere with your body's ability to control blood pressure. Examples include Parkinson's disease, multiple system atrophy, Lewy body dementia, pure autonomic failure, and amyloidosis.

• Eating: Some people experience a drop in blood pressure after eating a meal (postprandial hypotension). This is more common in older adults. This is because digestion takes blood away from other parts of your body, including your brain.

Factors that can increase the chance of feeling dizzy when standing up (orthostatic hypotension) include:

1. Getting Older: As people get older, their bodies' natural blood pressure control system, which uses special cells called baroreceptors near the heart and neck, can sometimes work less efficiently. This means the body might not respond quickly enough when blood pressure drops, which can cause dizziness. Also, the heart might not be able to pump as quickly to compensate for the drop. This is more common in people 65 and older.

2. Certain Medications: Many medicines can lower blood pressure and increase the risk of orthostatic hypotension. These include:

• Blood pressure and heart medications: These are commonly used to treat high blood pressure or heart conditions. Examples include diuretics (water pills), alpha blockers, beta blockers, calcium channel blockers, ACE inhibitors, and nitrates.
• Other medications: Other medicines that can contribute to the problem include those used to treat Parkinson's disease, some antidepressants, some antipsychotics, muscle relaxants, medications for erectile dysfunction, and pain relievers like narcotics.

3. Health Conditions: Some medical conditions make it more likely to experience orthostatic hypotension. These include:

• Heart problems: Conditions like heart valve issues, heart attack, and heart failure can affect the heart's ability to regulate blood pressure properly.
• Nerve problems: Diseases impacting the nervous system, like Parkinson's disease, and conditions causing nerve damage (neuropathy), such as diabetes, can also increase the risk.

4. Heat and Dehydration: Spending time in hot environments can cause you to sweat heavily and become dehydrated. Dehydration can reduce blood volume, leading to a drop in blood pressure and causing orthostatic hypotension.

5. Prolonged Bed Rest: Staying in bed for long periods, due to illness or injury, can weaken your body's ability to adjust to changes in posture. This weakness can make you prone to orthostatic hypotension.

6. Alcohol Consumption: Drinking alcohol can temporarily lower blood pressure and increase the risk of feeling dizzy when standing up.

Orthostatic hypotension, a condition where blood pressure drops too quickly when standing up, can lead to significant health problems, particularly for older adults. This happens because the body struggles to adjust blood flow quickly enough. Here are some of the potential issues:

• Falls: One of the most common dangers of orthostatic hypotension is a risk of falling. This is because the sudden drop in blood pressure can cause you to faint or feel dizzy, making you more prone to tripping and falling.

• Stroke: The fluctuating blood pressure associated with orthostatic hypotension can increase the chances of a stroke. When your blood pressure drops suddenly, it can reduce blood flow to the brain. This reduced blood supply can damage the brain and lead to a stroke.

• Heart problems: Orthostatic hypotension can also be a risk factor for various heart-related issues. It can contribute to heart disease, making you more susceptible to problems like chest pain (angina), heart failure, or irregular heartbeats (arrhythmias). The constant stress on the heart from the blood pressure fluctuations can weaken the heart over time.

Understanding and Treating Orthostatic Hypotension

Doctors aim to figure out the cause of orthostatic hypotension and find the best treatment. Sometimes, they can't pinpoint the exact reason.

To diagnose orthostatic hypotension, a doctor will review your medical history, medications, and symptoms, and perform a physical exam. They might also recommend some or all of these tests:

1. Electrocardiogram (ECG or EKG): This simple test measures the electrical activity of your heart. Small sensors (electrodes) are attached to your chest, and sometimes your arms and legs. Wires connect these sensors to a machine that records the results. An ECG can show problems with your heart's rhythm, structure, or the flow of blood and oxygen to the heart muscle. While helpful, an ECG might not catch infrequent heart rhythm issues. In such cases, your doctor might suggest a Holter monitor, a portable device you wear for a day or more to continuously track your heart's activity during your daily routine.

2. Blood Pressure Monitoring: This involves measuring your blood pressure while sitting and standing. A significant drop in blood pressure (a drop of 20 millimeters of mercury (mm Hg) in the top number (systolic pressure) or a 10 mm Hg drop in the bottom number (diastolic pressure) within 2 to 5 minutes of standing) is a sign of orthostatic hypotension.

3. Blood Tests: These tests give a general picture of your health. They can check for things like low blood sugar (hypoglycemia) or low red blood cell levels (anemia), which can both contribute to low blood pressure.

4. Echocardiogram: This test uses sound waves to create moving pictures of your heart. It shows the flow of blood through your heart and heart valves, and can identify structural heart problems.

5. Stress Test: A stress test is done while you exercise, like walking on a treadmill. If you can't exercise, medication might be used to make your heart work harder. Your heart's activity is monitored during the test using electrocardiography, echocardiography, or other methods.

6. Tilt Table Test: This test shows how your body responds to changes in position. You lie on a table that tilts, slowly moving from a lying to a standing position. Blood pressure is measured throughout the test.

7. Valsalva Maneuver: This test assesses the function of your autonomic nervous system. You breathe in deeply and forcefully push air out through your lips, as if trying to blow up a balloon. Your heart rate and blood pressure are monitored during this process.

These tests help doctors understand the root cause of orthostatic hypotension and develop an appropriate treatment plan.

Orthostatic hypotension happens when your blood pressure drops too much when you stand up. The treatment focuses on fixing the underlying reason for the low blood pressure, not just the low pressure itself.

For instance, if you're dehydrated, your doctor might tell you to drink more water. If a medicine is causing the problem, adjusting the dose or stopping the medicine could be the solution.

If you're only experiencing mild symptoms like feeling lightheaded when you stand up, simply sitting or lying down can often resolve it.

Sometimes, though, medicine is necessary. This might involve taking medication to raise your blood pressure or increase the amount of fluid in your blood. The best medicine depends on the specific cause of your orthostatic hypotension.

Several medications can help with orthostatic hypotension. These include midodrine (Orvaten), droxidopa (Northera), fludrocortisone, and pyridostigmine (Mestinon, Regonol).

Before starting any of these medications, it's crucial to talk to your doctor about the potential benefits and risks. They can help you decide which medication is right for you.

Managing or preventing orthostatic hypotension, a condition where blood pressure drops when standing up, is possible with simple lifestyle changes. These strategies can help your body maintain stable blood pressure.

Support Stockings:

Compression stockings, sometimes called support stockings, apply gentle pressure to your legs. This pressure helps improve blood flow, which can be helpful for orthostatic hypotension. A stocking aid, or "stocking butler," can assist with putting on these stockings if needed.

• Wear Compression Stockings: Wearing waist-high compression stockings during the day can help improve blood flow and ease symptoms. Take them off before bed and when you're lying down.

Hydration and Diet:

• Stay Hydrated: Drinking plenty of fluids, especially water, helps prevent low blood pressure. Drink extra water before extended periods of standing or activities that might trigger symptoms.
• Limit Alcohol: Alcohol can worsen orthostatic hypotension, so it's best to limit or avoid it entirely.
• Manage Salt Intake: Increasing your salt intake might be helpful, but only under the guidance of a healthcare professional. Too much salt can raise your blood pressure to unhealthy levels, potentially causing new health problems. Talk to your doctor before making any significant changes to your diet.
• Eat Smaller Meals: If your blood pressure drops after meals, eating smaller, lower-carbohydrate meals might help.

Exercise and Movement:

• Regular Exercise: Cardiovascular exercise and strength training can help your body manage orthostatic hypotension. Avoid exercising in extremely hot or humid conditions, as these can worsen symptoms.
• Specific Movement Techniques: Stretching and flexing your calf muscles before sitting up can be helpful. For symptom relief, try squeezing your thighs together, squeezing your stomach and buttock muscles, or doing squats, marching in place, or rising onto your toes.

Gradual Transitions:

• Gradual Transitions: Move slowly from a lying down to a standing position. When getting out of bed, sit on the edge of the bed for a few minutes before standing. This allows your body time to adjust to the change in position.

Sleep Adjustments:

• Elevate Your Head: Sleeping with your head slightly elevated can help combat the effects of gravity on your blood pressure.

These simple steps can help you manage or prevent orthostatic hypotension. If you're experiencing symptoms, consult with a healthcare professional for personalized advice and treatment.