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Orthostatic Hypotension

(Postural Hypotension)

Definition

Orthostatic hypotension is a sudden drop in blood pressure when a person stands.
Measuring of Blood Pressure
Placement of Blood Pressure Cuff
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Causes

There are many causes. Some common ones are:
  • Side effects from some medicines, such as blood vessel dilators and diuretics
  • Fluid loss due to bleeding, vomiting, diarrhea, or dehydration
  • Problems with the way the heart functions due to things like anemia, changes in rhythm, and heart failure
  • Endocrine problems, such as diabetes and hypothyroidism
  • Prolonged bedrest

Risk Factors

This problem is more common in people who are over 55 years of age, especially those with poorly controlled high blood pressure. Other things that may raise the risk are:
  • Longer periods of standing, mainly in heat
  • Long term or regular use of some medicines, such as diuretics and blood vessel dilators
  • Having certain heart or endocrine problems

Symptoms

Problems may be:
  • Lightheadedness
  • Blurred eyesight
  • Weakness
  • Fatigue
  • Fainting

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. Your blood pressure will be measured going from lying down or sitting to standing. This may also be done using a tilt-table. This is all that is needed to make the diagnosis.

Treatment

The goal of treatment is to ease or manage symptoms. This may include treating underlying health problems and:
  • Changing or stopping medicines that cause problems
  • Drinking plenty of water to treat or avoid dehydration
  • Eating smaller meals more often
  • Limiting or not drinking alcohol
  • Increasing salt in people who do not have high blood pressure
  • Slowly rising from a seated position and not standing for long periods of time

Prevention

There are no guidelines to prevent this problem. Older adults should talk to their doctors about the medicines they take.

RESOURCES

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov
National Organization for Rare Disorders
http://www.rarediseases.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca/en/health-canada.html
Heart and Stroke Foundation
http://www.heartandstroke.ca

References

Orthostatic hypotension information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Orthostatic-Hypotension-Information-Page. Updated March 27, 2019. Accessed December 10, 2019.
Orthostatic hypotension and orthostatic syncope. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/orthostatic-hypotension-and-orthostatic-syncope . Updated February 26, 2019. Accessed December 10, 2019.
3/24/2015 DynaMed Systematic Literature Surveillance https://www.dynamed.com/condition/orthostatic-hypotension-and-orthostatic-syncope: Mills PB, Fung CK, et al. Nonpharmacologic management of orthostatic hypotension: A systematic review. Arch Phys Med Rehab. 2015;96(20):366-375.

Revision Information

  • Reviewer: EBSCO Medical Review Board James Cornell, MD
  • Review Date: 09/2019
  • Update Date: 12/10/2019
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