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Orthostatic Hypotension

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(Postural Hypotension)

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
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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:
  • 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

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.

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.

Treatment

Treatment for orthostatic hypotension depends on the cause.
Treatments include:

Adjusting Dosage or Type of Medication

When orthostatic hypotension is due to hypovolemia related to medications, adjusting or stopping medication may be needed to reverse the condition.

Treating Dehydration

Orthostatic hypotension resulting from dehydration is treated with fluids and electrolyte replacement.

Minimizing Bedrest

If bedrest is the cause of orthostatic hypotension, symptoms may be improved by increasing time spent sitting up in bed.

Medications

A number of medications may be given to boost blood pressure. Over-the-counter medications include caffeine and ibuprofen.

Other Interventions

In some cases, individuals may be encouraged to increase their intake of salt. Fitted elastic stockings that go up to the waist may be worn. Individuals may need to be taught to rise from lying down, to sit up, and to stand in a slow and gradual manner. Similarly, they should be discouraged from standing still for too long a time.
If you are diagnosed with orthostatic hypotension, follow your doctor's instructions .
If you are diagnosed with orthostatic hypotension, follow your doctor's instructions .

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.

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 http://www.hc-sc.gc.ca

Heart and Stroke Foundation http://ww2.heartandstroke.ca

References

Berkow R, Beers MH, Fletcher AJ, eds. The Merck Manual of Medical Information—Home Edition . 2nd ed. Simon and Schuster, Inc; 2003.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment . 8th ed. St. Louis, MO: Mosby; 2006.

Goldman L. Cecil Textbook of Medicine . 22nd ed. Philadelphia, PA: Saunders; 2004.

Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007;120:841-847. Review.

Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet . 2005;366:665-675.

NINDS orthostatic hypotension information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/orthostatic%5Fhypotension/orthostatic%5Fhypotension.htm . Updated September 30, 2011. Accessed March 25, 2013.

Orthostatic syncope. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 9, 2012. Accessed March 25, 2013.

Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120:975-980.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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