From the Guidelines
Orthostatic hypotension (OH) is the medical term for getting dizzy when standing up due to a drop in blood pressure caused by gravity. This condition occurs when your body doesn't adjust quickly enough to the change in position, resulting in decreased blood flow to the brain. According to the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1, OH is defined as a drop in systolic BP of ≥20 mm Hg or diastolic BP of ≥10 mm Hg with assumption of an upright posture. Common symptoms of OH include:
- Lightheadedness
- Blurred vision
- Weakness
- Sometimes fainting To manage orthostatic hypotension, you should:
- Change positions slowly, especially when getting up from lying down
- Stay well-hydrated
- Consider wearing compression stockings to improve blood return from the legs Some medications that may help include fludrocortisone (Florinef) at 0.1-0.2 mg daily or midodrine (ProAmatine) at 2.5-10 mg three times daily, but these require a prescription and medical supervision 1. Salt intake may need to be increased unless contraindicated by other conditions. This condition occurs because normally when we stand, blood vessels constrict and heart rate increases to counteract gravity's pull on blood, but in orthostatic hypotension, this compensatory mechanism fails, causing blood to pool in the lower extremities and reducing cerebral perfusion.
From the Research
Definition and Causes
- Orthostatic hypotension is a condition characterized by a significant drop in blood pressure when standing up, leading to dizziness, lightheadedness, and potentially syncope 2, 3.
- This condition can be caused by various factors, including autonomic nervous system dysfunction, dehydration, and certain medications 4, 5.
Symptoms and Diagnosis
- Symptoms of orthostatic hypotension include dizziness, lightheadedness, fainting, and blurred vision 2, 3.
- Diagnosis is typically made by measuring blood pressure and heart rate while the patient is standing and sitting or lying down 3, 5.
Treatment and Management
- Treatment for orthostatic hypotension often involves non-pharmacological measures, such as increasing fluid and salt intake, avoiding large meals, and elevating the head of the bed 4, 5.
- Pharmacological options, including midodrine, fludrocortisone, and droxidopa, may be used to help manage symptoms 2, 6, 4, 5.
- The choice of treatment depends on the underlying cause of the condition and the patient's individual needs and medical history 4, 5.