Orthostatic Hypotension

Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.

  • Causes

    Orthostatic hypotension has several causes.


    • Hypovolemia is the most common cause. It may be due to:

      • Excessive use of loop diuretic medications
      • Vasodilator medications, such as nitrate preparations, Ca blockers, or ACE inhibitors
      • Dehydration
      • Prolonged bedrest
      • Addison’s disease
        with inadequate salt intake

    • Impaired autonomic (nerve) reflex due to certain diseases:

      • Diabetes
      • Pernicious anemia
      • Amyloidosis
      • Guillain-Barre syndrome
      • Riley-Day syndrome
      • Shy-Drager syndrome
    • Decreased heart muscle contractility or vascular responsiveness

    • Certain drugs:

      • Monoamine oxidase (MAO) inhibitors
      • Tricyclic antidepressants
      • Tetracyclic antidepressants
    • Phenothiazine antipsychotic drugs, such as chlorpromazine, promazine,
      thioridazine
    • Atypical antipsychotics
    • Quinidine
    • Levodopa
    • Barbiturates
    • Alcohol

  • Definition

    Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.

    Measuring of Blood Pressure
    Placement of Blood Pressure Cuff
    Copyright © Nucleus Medical Media, Inc.

  • Diagnosis

    Orthostatic hypotension is diagnosed when symptoms are present and there is a measured reduction in blood pressure while standing, which is relieved by lying down.

  • Prevention

    There is no way to prevent orthostatic hypotension if it is a result of other diseases or conditions. However, if your orthostatic hypotension relates to medications, dehydration, or bedrest, you should talk with your healthcare provider about treatment options.

  • Risk Factors

    Factors that increase your chances of getting orthostatic hypotension include:

    • Increased age

    • Use of certain drugs:

      • Loop diuretics
      • Vasodilators
      • MAO inhibitors
      • Tricyclic antidepressants
      • Tetracyclic antidepressants
      • Phenothiazine antipsychotic drugs
      • Quinidine
      • Levodopa
      • Barbiturates
      • Alcohol
    • Inadequate fluid intake
    • Prolonged bedrest

    • Certain diseases or conditions:

      • Atherosclerosis

      • Advanced
        heart failure
      • Addison’s disease
      • Diabetes
      • Pernicious anemia
      • Amyloidosis
      • Guillain-Barre syndrome
      • Riley-Day syndrome
      • Shy-Drager syndrome

  • Symptoms

    Symptoms of orthostatic hypotension include:


    • Mild to moderate reduction in brain blood flow:

      • Faintness
      • Light-headedness
      • Weakness
      • Confusion
      • Visual blurring

    • Severe reduction in brain blood flow:

      • Fainting
        or brief loss of consciousness

    Exercise or having eaten a heavy meal may worsen symptoms.

    If you experience any of these symptoms do not assume it is due to orthostatic hypotension. These symptoms may be caused by other health conditions.

  • Treatment

    Treatment for orthostatic hypotension depends on the cause.

    Treatments include:


    If you are diagnosed with orthostatic hypotension, follow your doctor's
    instructions
    .