Orthostatic Hypotension

Orthostatic Hypotension is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint. You probably also feel your heart beat faster when you experience this drop in blood pressure. Both are a reaction to orthostatic hypotension. Postural orthostatic tachycardia syndrome (POTS) is an extreme and rare form of Orthostatic Hypotension. Dizziness can of course be caused by other problems.

Other Orthostatic Hypotension signs and symptoms may include:

  • Feeling lightheaded or dizzy after standing up
  • Blurry vision
  • Weakness
  • Fainting (syncope)
  • Confusion
  • Nausea
  • Headache

When changing position to upright, gravity will pool blood at the lowest point in your body, your lower legs, causing less blood to flow back to your heart.  Your heart tries to compensate by beating faster and thus pump more blood. Your face may get flushed when that happens, because your head is getting preferential treatment because of your brain.

So far this is a normal physiological reaction to spending a prolonged time in a prone or sitting position. Usually, the simplest treatment is to take your time getting up before standing and make sure you are well hydrated.

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Some factors that may cause Orthostatic Hypotension:

  • Dehydration. Fever, vomiting, not drinking enough fluids, severe diarrhea and strenuous exercise can all lead to dehydration.
  • Heart problems. Any heart condition that decreases its function to pump blood around your body.
  • Anemia.
  • Age. As your body ages, the ability of special cells (baroreceptors) near your heart and neck arteries to regulate blood pressure can be slowed. Also, it may be harder for your heart to beat faster and compensate for drops in blood pressure.
  • Medications. Some medications such as high blood pressure medication have a greater risk of orthostatic hypotension. These include
    • Diuretics and other drugs that treat high blood pressure;
    • Heart medications, such as beta blockers;
    • Viagra, particularly in combination with nitroglycerin;
    • Alcohol.
  • Heat exposure. Sweating can cause dehydration.
  • Pregnancy. Because a woman's circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This could cause blood pressure to drop enough to cause orthostatic hypotension when standing up quickly.

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Tests may include:

  • Blood pressure monitoring while you're sitting and during activities.
  • Blood tests.
  • Electrocardiogram (ECG)
  • Echocardiogram.
  • Stress test.
  • Tilt table test. A tilt table test evaluates how your body reacts to changes in position.

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Treatments include:

  • When low blood pressure is caused by medications, treatment usually involves changing the dose or stopping it entirely.
  • Lifestyle changes. Drink plenty of fluids, such as water; limit your alcohol intake;
  • Compression stockings.

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Some other causes of dizziness and vertigo:

  • Head injury,
  • In older people, the most common cause is degeneration of the vestibular system of the inner ear.
  • Viruses affecting the ear such as those causing vestibular neuritis,
  • Stroke,
  • Ménière's disease.

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