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
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Orthostatic hypotension has several causes.
Hypovolemia is the most common cause. It may be due to:
Excessive use of loop diuretic medicationsVasodilator medications, such as nitrate preparations, calcium channel blockers, or ACE inhibitorsDehydrationProlonged bedrestAddison’s disease
with inadequate salt intake
Impaired autonomic (nerve) reflex due to certain diseases:
DiabetesPernicious anemiaAmyloidosisGuillain-Barre syndromeRiley-Day syndromeShy-Drager syndromeDecreased heart muscle contractility or vascular responsiveness
Monoamine oxidase (MAO) inhibitorsTricyclic antidepressantsTetracyclic antidepressantsPhenothiazine antipsychotic drugs, such as chlorpromazine, promazine,
Factors that increase your chance of orthostatic hypotension include: Increased age
Use of certain drugs:
Loop diureticsVasodilatorsMAO inhibitorsTricyclic antidepressantsTetracyclic antidepressantsPhenothiazine antipsychotic drugsQuinidineLevodopaBarbituratesAlcoholInadequate fluid intakeProlonged bedrest
Certain diseases or conditions:
heart failureAddison’s diseaseDiabetesPernicious anemiaAmyloidosisGuillain-Barre syndromeRiley-Day syndromeShy-Drager syndrome
Orthostatic hypotension may cause:
Mild to moderate reduction in brain blood flow:
Severe reduction in brain blood flow:
or brief loss of consciousness
Exercise or having eaten a heavy meal may worsen symptoms.
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 for orthostatic hypotension depends on the cause.
When orthostatic hypotension is due to hypovolemia related to medications, adjusting or stopping medication may be needed to reverse the condition.
Orthostatic hypotension resulting from dehydration is treated with fluids and electrolyte replacement.
If bedrest is the cause of orthostatic hypotension, symptoms may be improved by increasing time spent sitting up in bed.
A number of medications may be given to boost blood pressure. Over-the-counter medications include caffeine and ibuprofen.
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.
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.
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Last reviewed August 2014 by Michael J. Fucci, DO
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