What Is Postural Hypotension?
Antonio_Diaz / Getty Images
Medically reviewed by Rafle Fernandez, MD
Postural hypotension, also known as orthostatic hypotension, happens when your blood pressure falls significantly upon standing after lying down or sitting. The sudden blood pressure drop can make some people feel lightheaded or dizzy, which can lead to falls and injuries—especially among older adults.
Whenever a person stands up, gravity pulls blood down into the legs. This means for a short time, there's less blood for the heart to pump upward, which can temporarily lower blood pressure. In most people, the body quickly adjusts to the position change and keeps blood pressure steady. But if you have postural hypotension, the body doesn't react as it should, which results in a significant decrease in blood pressure within several minutes of standing up.
Postural hypotension affects about 6% of the United States population, and risk increases with age.
Editor's Note: Hypotension is the medical term for low blood pressure. The term "postural hypotension" refers to low blood pressure due to a change in posture—e.g., when you move from sitting or lying down to standing up. The term orthostatic hypotension refers to the same thing—the word "orthostasis" means to stand up.
Types of Postural Hypotension
Postural hypotension can be categorized into two types based on when you start to feel its effects.
Classic orthostatic hypotension is when your symptoms kick in within three minutes of standing. Delayed orthostatic hypotension is when your symptoms start more than three minutes after you've stood up.
More research has been done and more is understood about classic orthostatic hypotension.
Postural Hypotension Symptoms
People with postural hypotension may experience a range of symptoms. Most commonly, you'd feel lightheaded or dizzy. Fainting or falling is also common.
Some people may experience other, less common, symptoms including:
Increased weakness or tiredness
Difficulty breathing
Chest discomfort or pain
Back pain
Pain in the legs
Trouble focusing or thinking clearly
Symptom severity can vary; often, they are mild.
Sometimes, people with postural hypotension don't have any symptoms. In these cases, the condition might only be discovered during a routine medical check-up.
Postural Hypotension Causes
Postural hypotension happens when your body can't keep blood pressure stable when you go from sitting or lying down to standing up. The condition can have many causes, which are grouped into two main categories: neurogenic and non-neurogenic.
Neurogenic Causes
Neurogenic causes are the less common causes of postural hypotension. Neurogenic means the condition happens because of issues with the autonomic nervous system. This part of your nervous system handles tasks in the body you don't consciously control, such as maintaining blood pressure. When there's a disorder affecting the autonomic nervous system, the system can't properly make adjustments to certain changes, such as when you stand up from sitting or lying down.
Conditions that can disrupt the autonomic nervous system and cause postural hypotension include Parkinson's disease, Guillain-Barré syndrome, and diabetes. Certain infections and forms of dementia can also cause blood pressure to drop.
Non-Neurogenic
The other, more common causes are non-neurogenic, meaning they are linked to environmental or health issues rather than problems with the autonomic nervous system. These factors include having heart disease, drinking alcohol, and getting older. Other non-neurogenic causes of postural hypotension are related to blood volume depletion, which includes conditions such as dehydration, anemia, and hemorrhage.
Certain medications can also increase the risk of postural hypotension. These include heart-related drugs like water pills (diuretics), certain heart disease medications, and drugs that affect heart rate and blood vessel tension. Medications for mental health conditions, such as depression and anxiety, and sleep and mood disorders can also contribute to postural hypotension.
Diagnosis
Diagnosing postural hypotension will probably include a thorough discussion of your medical history with your healthcare provider. They may also want to know what was happening right before any symptoms (if any) started and review any medications you take
The diagnosis process will also include a physical examination. The healthcare provider will likely check vital signs like blood pressure and heart rate as you are lying down and standing up to see how the body responds to changes in position.
A postural hypotension diagnosis requires a certain change in blood pressure within three minutes of standing after having lain down for five minutes: Either your systolic blood pressure (the top number) must have decreased by at least 20 millimeters of mercury (mmHg) or your diastolic blood pressure (the bottom number) must have decreased by 10 mmHg.
The healthcare provider may order additional tests based on what they find. This can include a cardiac exam and a neurologic exam. A cardiac exam involves listening to the heart with a stethoscope, checking blood pressure, and running other tests to assess heart function. A neurologic exam tests reflexes, muscle strength, sensory function, coordination, and mental status.
Treatments for Postural Hypotension
In the actual moments you are experiencing postural hypotension, the goal is to avoid your risk of fall and injury. Sit or lie down when you feel a sudden drop in blood pressure upon standing. This should help you recover.
For the treatment of postural hypotension overall, the goal is to reduce its occurrence and symptom impact so you can avoid falls and related injuries and improve your quality of life.
Healthcare providers will focus on addressing the cause of postural hypotension, such as infections, dehydration, or anemia. For cases where medication is the cause, treatment may involve stopping or changing the amount of the medication causing the issue or switching to a different type of medication.
Introducing medication may also be considered. There are various medications available that work in different ways to help manage the condition by improving blood vessel function.
How To Prevent
Depending on the cause, you might be able to prevent postural hypotension. For instance, if dehydration is the cause, you can stay hydrated to prevent episodes.
However, you might not always be able to prevent postural hypotension as a whole since some conditions that cause it aren't always preventable, as is the case with Parkinson's disease.
Regardless of whether your underlying cause is preventable, there are lifestyle changes you can make to try to prevent episodes of postural hypotension. You can do the following to manage your postural hypotension:
Move slowly when changing positions, and go step-by-step (e.g., instead of moving from lying down straight to standing up, move from lying down to sitting up to standing)
Stay hydrated
Avoid drinking alcohol, staying in hot places (including showers and baths), and eating large meals
Elevate the head of the bed while sleeping
Follow a regular exercise routine
Tense the leg and hip muscles after standing up
Complications
Orthostatic hypotension can make it harder for people to move around, keep their balance, and do everyday activities on their own. Research has shown that this condition can increase the risk of several health issues, including:
Falls and related injuries
Heart disease
Atrial fibrillation, a type of irregular heartbeat
These complications lead to an increased risk of death for people with orthostatic hypotension.
A Quick Review
Postural hypotension, also referred to as orthostatic hypotension, occurs when a person's blood pressure drops significantly upon standing from a sitting or lying position. This condition can cause symptoms like dizziness, lightheadedness, and even fainting. It is often triggered by factors such as dehydration, certain medications, and underlying health issues like anemia.
Managing postural hypotension involves lifestyle adjustments like taking more time to stand up from lying down or sitting or staying hydrated. Sometimes medication to increase blood pressure can help. Because postural hypotension can lead to falls and associated injuries, it's important to treat the underlying cause or try to prevent future episodes.
Frequently Asked Questions
What drugs cause postural hypotension?
Heart-related drugs like water pills (diuretics), certain heart disease medications, and drugs that affect heart rate and blood vessel tension can cause postural hypotension. Medications used for depression, anxiety, and sleep or mood disorders may also contribute to postural hypotension.
Does drinking water help with postural hypotension?
Staying well-hydrated helps maintain blood volume and pressure. Drinking 6-8 glasses of water or low-calorie drinks daily is a potential way to manage postural hypotension. However, it's important to follow any specific guidelines about fluid intake given by your healthcare provider, especially if you have been advised to limit how much you drink due to other health conditions.
Can low blood pressure cause a stroke?
While high blood pressure (hypertension) is a well-known risk factor for stroke, low blood pressure may also pose risks for a stroke. Even if symptoms are not present or are minimal, postural hypotension may still increase the risk of stroke.
For more Health.com news, make sure to sign up for our newsletter!
Read the original article on Health.com.
