Orthostatic Hypotension: Why You Feel Dizzy When Standing and How to Manage It

What is orthostatic hypotension?

Orthostatic hypotension is a sudden drop in blood pressure that occurs when you move from a seated or lying position to standing. Orthostatic hypotension symptoms could include dizziness, lightheadedness, blurred vision, and even fainting. The condition is also referred to as postural hypotension.

What is blood pressure?

Blood pressure is the force exerted by blood against the walls of your arteries. It's measured in millimetres of mercury (mmHg) and consists of two numbers:

• Systolic pressure: The top number, which measures the pressure when your heart beats
• Diastolic pressure: The bottom number, which measures the pressure between heartbeats

Normal blood pressure is around 120/80 mmHg. Hypotension, or low blood pressure, is generally considered a reading of 90/60 mmHg or lower.

What BP is orthostatic hypotension?

Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20 mmHg or a drop in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing up. This significant decrease in blood pressure reduces blood flow to the brain, causing the characteristic symptoms of orthostatic hypotension or postural hypotension.

Who might get orthostatic hypotension?

While orthostatic hypotension can affect anyone, certain groups are at higher risk:

• Older adults: The body's ability to regulate blood pressure declines with age.
• People who have been on prolonged bed rest: This can weaken the cardiovascular system.
• Pregnant women: Orthostatic hypotension causes could include hormonal changes and increased blood volume during pregnancy.
• Individuals with underlying health conditions: Parkinson's disease, heart problems, diabetes, and neurological disorders increase the likelihood of postural hypotension.

How common is orthostatic hypotension?

Orthostatic hypotension affects about 6% of the general population. However, it's more common in older adults, with 10-30% of people over 65 experiencing symptoms. The condition is also prevalent in long-term care facilities and among those who have recently given birth or undergone growth spurts.

What are the symptoms of orthostatic hypotension?

Orthostatic hypotension symptoms are the body’s response to a sudden drop in blood pressure when standing up. Here are the key symptoms:

• Dizziness or Lightheadedness: Feeling unsteady or faint upon standing
• Blurred Vision: Vision may temporarily become fuzzy or out of focus
• Fainting (Syncope): In severe cases, sudden loss of consciousness can occur
• Nausea: A sensation of queasiness or the urge to vomit
• Fatigue: Sudden weakness or tiredness may accompany other orthostatic hypotension symptoms
• Confusion: Some may experience disorientation or mental fog
• Muscle Tremors: Shaky or trembling muscles can occur

These orthostatic hypotension symptoms usually improve once you sit or lie down. In more serious cases, symptoms may lead to falls or injuries, so prompt awareness and care are essential.

What causes orthostatic hypotension?

Orthostatic hypotension causes are generally grouped into two main categories: neurogenic and non-neurogenic.

• Neurogenic Causes: These are related to disorders that impair the autonomic nervous system’s ability to regulate blood pressure. Conditions such as Parkinson's disease, multiple system atrophy, and diabetic neuropathy fall under this category, as they can disrupt the body’s blood pressure adjustments upon standing, leading to orthostatic hypotension.
• Non-Neurogenic Causes: Non-neurogenic orthostatic hypotension causes include factors unrelated to the nervous system. Dehydration, blood loss, and certain medications (like diuretics and antidepressants) can reduce blood volume or pressure. Additionally, heart conditions that affect circulation, as well as environmental factors like prolonged standing or exposure to heat, can contribute to the sudden drop in blood pressure when standing up.

How is orthostatic hypotension diagnosed?

To diagnose orthostatic hypotension, your doctor will:

• Review your medical history and medications: Certain drugs or health conditions can contribute to blood pressure drops.
• Conduct a physical examination: This helps identify any underlying conditions affecting blood pressure regulation.
• Measure blood pressure in different positions: Blood pressure will be recorded while you are lying down, sitting, and standing to observe any significant drops.
• Order blood tests: Tests can reveal anaemia, low blood sugar, or other metabolic issues contributing to symptoms.
• Assess heart function: An echocardiogram may be used to evaluate your heart’s performance.

Additional tests, such as a tilt table test, may be recommended based on your symptoms and health status.

How do you fix orthostatic hypotension?

Orthostatic hypotension treatment often involves addressing the underlying cause:

• Treating dehydration with fluids
• Adjusting medications that may contribute to the condition
• Managing heart conditions
• Making lifestyle changes, such as:
  • Rising slowly from a seated or lying position
  • Avoiding prolonged standing or hot environments
  • Eating smaller, more frequent meals to prevent post-meal dizziness

What medications/treatments are used in orthostatic hypotension?

Depending on the severity and cause, an orthostatic hypotension treatment plan could include:

• Medications to increase blood volume
• Drugs that constrict blood vessels
• Compression stockings to improve blood flow in the legs
• Increased salt and fluid intake
• Physical therapy to improve muscle strength and circulation

Side effects of the treatment

While orthostatic hypotension treatment is generally well-tolerated, some medications may cause side effects like:

• Headaches
• Palpitations
• Fluid retention
• Supine hypertension (high blood pressure when lying down)

Work closely with your doctor to find the right treatment plan that minimises side effects and effectively manages your symptoms.

What are the complications of orthostatic hypotension?

Orthostatic hypotension can lead to several complications, primarily due to reduced blood flow to the brain and other organs. Some potential complications include:

• Falls and injuries: Dizziness and fainting can increase the risk of falls, which may result in fractures, head injuries, or other trauma.
• Cardiovascular problems: Chronic low blood pressure can strain the heart and may increase the risk of heart failure or arrhythmias.
• Cognitive impairment: Repeated episodes of reduced blood flow to the brain may contribute to cognitive decline and dementia.

How can we reduce our risk of orthostatic hypotension?

Several strategies can help reduce your risk of developing orthostatic hypotension or manage your symptoms if you already have the condition:

• Stay hydrated: Drink plenty of water throughout the day to maintain adequate blood volume.
• Avoid sudden position changes: Take your time when standing up, and pause for a few moments before walking.
• Wear compression stockings: These garments help promote blood flow from your legs back to your heart.
• Adjust your diet: Eat smaller, more frequent meals and limit alcohol intake, as both can contribute to low blood pressure.
• Exercise regularly: Engaging in physical activity can improve your overall cardiovascular health and help regulate blood pressure.
• Reviewing your medications: Some medications, like diuretics or antidepressants, can contribute to low blood pressure. Your doctor may adjust your dosage or switch you to an alternative medication.

What can we expect if we have orthostatic hypotension?

If you have orthostatic hypotension, your healthcare provider will work with you to identify the underlying cause and develop an appropriate treatment plan. It's essential to follow your treatment plan consistently and communicate any concerns or changes in your symptoms to your healthcare provider.

What is the outlook for orthostatic hypotension?

The outlook for orthostatic hypotension depends on the underlying cause and the effectiveness of treatment. Many people can manage their symptoms and reduce their risk of complications by implementing lifestyle changes and following their prescribed treatment plan. However, some individuals may experience persistent symptoms or develop complications, particularly if the condition is caused by an underlying chronic illness.

Are orthostatic hypotension and postural tachycardia syndrome (POTS) the same condition?

While orthostatic hypotension and postural tachycardia syndrome (POTS) share some similarities, they are distinct conditions. Both involve changes in blood pressure and heart rate upon standing, but the specific patterns differ:

• Orthostatic hypotension: Characterised by a significant drop in blood pressure upon standing, often accompanied by dizziness or fainting.
• POTS: Characterised by a rapid increase in heart rate upon standing (at least 30 beats per minute), without a significant drop in blood pressure. Symptoms may include dizziness, fatigue, and palpitations.

When to see a doctor?

If you experience frequent episodes of dizziness, lightheadedness, or fainting upon standing, it's essential to consult your healthcare provider. They can help diagnose the underlying cause of your symptoms and recommend an appropriate treatment plan. Seeking medical attention is particularly important if your symptoms are severe, persistent, or interfere with your daily activities.

Conclusion

Orthostatic hypotension is a common condition that can impact your daily life. By understanding the causes, symptoms, and treatment options, you can take steps to manage your symptoms and reduce your risk of falls and injuries.

At Metropolis Healthcare, our team of experts is dedicated to providing accurate diagnostic testing and personalised care to help you prioritise your health. With a network of advanced labs across India and convenient at-home sample collection services, we make managing conditions like orthostatic hypotension easier. Take control of your well-being today by booking a health check-up or exploring our comprehensive range of pathology tests.