Orthostatic hypotension

Overview

Orthostatic hypotension is a drop in blood pressure that happens when you stand up from sitting or lying down. It can make you feel dizzy or lightheaded, and sometimes cause fainting.

Yes, orthostatic hypotension is quite common, particularly among older adults. It affects up to 20% of people over 65.

It affects older adults most often, but it can also happen to people with diabetes, Parkinson's disease, or heart problems, and those who take certain medications like blood pressure pills or antidepressants.

Symptoms

Common symptoms

• Dizziness or lightheadedness when standing up
• Blurred vision
• Feeling weak or tired
• Nausea
• Fainting (syncope)

Symptoms in children

• Dizziness or lightheadedness when standing
• Feeling unusually tired or weak
• Fainting, especially after standing quickly
• Nausea or stomach discomfort

Symptoms in older adults

• Dizziness or lightheadedness
• Fainting or near-fainting, which can lead to falls
• Confusion or trouble thinking clearly
• Neck or shoulder pain when standing (known as 'coat hanger' pain)

Causes

Main causes

• Dehydration (not drinking enough fluids)
• Prolonged bed rest or sitting without moving
• Medications such as blood pressure pills, diuretics, or some antidepressants
• Nervous system disorders like Parkinson's disease or diabetes-related nerve damage
• Heart problems that affect how well the heart pumps blood

Risk factors

• Being over age 65
• Having diabetes, Parkinson's disease, or heart disease
• Taking certain medications that lower blood pressure
• Pregnancy
• Anemia (low red blood cell count)

When to see a doctor

See a doctor urgently if:

• If you faint and hurt yourself, or if you have chest pain, severe headache, or trouble seeing or speaking
• If your symptoms come with a very fast or slow heartbeat

Book a routine appointment if:

• If you often feel dizzy or lightheaded when standing
• If you have fainted once and are worried
• If you have other health conditions and notice new symptoms

Diagnosis

Your doctor will check your blood pressure while you are lying down, sitting, and standing. They will look for a significant drop within a few minutes of standing.

Tests that may be done

• Orthostatic blood pressure measurements (lying, sitting, standing)
• Blood tests to check for anemia, dehydration, or other causes
• Electrocardiogram (ECG) to look at heart function
• Tilt table test, where you lie on a table that tilts up to see how your body reacts

What to expect at your appointment

The tests are simple and non-invasive. Your doctor may ask you to stop or adjust some medications before testing. The results help find the cause and guide treatment.

Treatment

Treatment focuses on managing the cause and reducing symptoms. For many people, lifestyle changes are enough. If necessary, a doctor may adjust medications or prescribe treatments to raise blood pressure.

Self-care at home

• Stand up slowly from lying or sitting
• Drink plenty of fluids, especially water
• Avoid alcohol and caffeine if they make symptoms worse
• Wear compression stockings to help blood flow
• Elevate the head of your bed slightly at night

Medical treatments

If lifestyle changes are not enough, your doctor may recommend increasing salt in your diet (only if your blood pressure allows), or prescribe a medication that helps raise blood pressure. Never change your dose of any medication without talking to your doctor first.

Living with this condition

Living with orthostatic hypotension means learning to be mindful when changing positions. Always stand up slowly and hold onto something if you feel dizzy. Plan your day to include regular meals and enough water.

Lifestyle tips

• Get up gradually – from lying to sitting for a minute, then standing
• Drink a glass of water before getting out of bed
• Avoid hot showers or baths that can cause blood vessels to widen
• Exercise regularly to improve blood flow, but check with your doctor first

Diet and exercise

A balanced diet with enough salt (if your doctor allows) can help. Small, frequent meals may prevent blood pressure drops after eating. Gentle exercises like walking or leg raises can improve circulation.

Mental health and emotional wellbeing

Frequent dizziness or fear of fainting can cause anxiety or depression. It is important to talk about these feelings with your doctor or a mental health professional. You are not alone.

Prevention

Some cases can be prevented by staying hydrated, moving slowly when standing, and avoiding dehydration. However, if it is caused by another medical condition, prevention may not always be possible.

Screening programmes

If you are at higher risk – for example, if you are older or have diabetes – ask your doctor to check your blood pressure when standing during a routine visit.

Complications

If left untreated

• Falls and related injuries like fractures or head trauma
• Fainting spells that can be dangerous if driving or operating machinery
• Chronic fatigue and reduced quality of life

Long-term outlook

For most people, orthostatic hypotension can be managed well with lifestyle changes and medical care. With the right steps, many people reduce their symptoms and continue their daily activities safely.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.