Orthostatic Hypotension
Orthostatic hypotension is a sustained drop in blood pressure on standing because circulatory reflexes or blood volume do not maintain brain perfusion.
Key takeaways
- Symptoms and measured lying-to-standing pressure are both important because dizziness has many non-blood-pressure causes.
- Dehydration, blood loss, antihypertensives, antidepressants, Parkinson disease and autonomic neuropathy are common contributors.
- Compression, fluid and salt advice, and medicines such as midodrine have different risks and depend on the cause.
The listings below do not establish neurogenic hypotension; heart, kidney, medicine and volume status should be assessed first.
Confirming the pattern
Blood pressure and pulse are measured after lying and during several minutes of standing. A blunted pulse response can suggest autonomic failure, while a strong increase favours volume depletion. ECG, blood count and metabolic tests are selected from history.
Reducing symptoms and falls
Rise in stages, maintain appropriate hydration and review culprit medicines. Physical counter-pressure manoeuvres, abdominal binders or compression can help. Fludrocortisone expands volume and midodrine raises vascular tone, but both can cause high lying blood pressure and need monitoring.
When to seek urgent care
Seek urgent care for fainting with chest pain, palpitations, severe breathlessness, major injury, black or bloody stool, new neurological symptoms or persistent inability to stand safely.