What does orthostatic hypotension mean?

Orthostatic hypotension, also known as postural hypotension, refers to a significant drop in blood pressure when standing upright due to impaired autonomic reflexes or severe intravascular volume depletion, leading to symptoms such as dizziness, syncope, or even cardiovascular and cerebrovascular events.

Which department should I visit for orthostatic hypotension?

Departments: Neurology, Cardiovascular Medicine, General Internal Medicine, Emergency Department.

What causes orthostatic hypotension?

Many conditions affecting the autonomic nervous system (e.g., diabetic peripheral neuropathy, neurodegenerative diseases like multiple system atrophy) can cause orthostatic hypotension. Other causes include acute or chronic hypovolemia, medications (especially antihypertensives like nitrates and calcium channel blockers, as well as certain antidepressants, opioids, and alcohol), advanced age, and heart diseases.

Who is more likely to develop orthostatic hypotension?

It is more common in the elderly but can also occur in young and middle-aged adults. Studies show that nearly 20% of individuals over 65 experience orthostatic hypotension.

What are the symptoms of orthostatic hypotension?

• Normally, standing upright causes a slight decrease in systolic blood pressure (5–10 mmHg), a slight increase in diastolic pressure (5–10 mmHg), and a mild rise in heart rate (10–25 bpm). However, in orthostatic hypotension, standing for 2–5 minutes results in a drop of at least 20 mmHg in systolic pressure or 10 mmHg in diastolic pressure compared to resting supine measurements.
• Patients often experience symptoms of cerebral hypoperfusion upon sudden posture changes, after meals, exertion, or prolonged standing. These include weakness, dizziness, lightheadedness, blurred or darkened vision, and in severe cases, syncope (reflex fainting). Rarely, it may trigger cardiovascular or cerebrovascular events like angina or stroke.
• Some patients may present with atypical symptoms such as fatigue, memory decline, leg weakness, blurred vision, or head/neck pain.

How is orthostatic hypotension diagnosed?

Diagnosis relies on medical history and orthostatic blood pressure monitoring. For confirmed cases, further evaluation of medical/drug history, cardiac/neurological exams, and auxiliary tests are needed to identify underlying causes and triggers.

How is orthostatic hypotension treated?

Treatment includes addressing the underlying cause and symptomatic relief. The former targets specific conditions contributing to orthostatic hypotension, while the latter focuses on alleviating symptoms.

Symptomatic treatment: Non-pharmacological (e.g., discontinuing causative medications, lifestyle/dietary adjustments) and pharmacological interventions.

• Lifestyle measures: Slow posture changes (lying → sitting → standing), avoiding exertion/coughing/hot environments, increased fluid intake, elevating the bedhead (10°–20°), wearing compression stockings/abdominal binders, and leg-crossing while standing.
• Dietary adjustments: Increased salt and water intake.
• Medications (if non-drug methods fail): Midodrine or droxidopa.

Can orthostatic hypotension lead to serious complications?

Prognosis depends on the underlying cause. With active non-drug and drug interventions, severe outcomes are rare. Lifestyle and dietary measures are crucial for management.

How to prevent orthostatic hypotension?

When rising from lying/squatting, do so slowly—e.g., after using the toilet, use support (knees, walls) to stand gradually.

Replenish fluids promptly after fluid loss (e.g., diarrhea, heavy sweating)—oral rehydration solutions for diarrhea or sports drinks post-exercise.

Treat underlying conditions (especially cardiovascular/cerebrovascular diseases) with standardized care to control blood pressure and reduce risk.

For medications causing orthostatic hypotension (e.g., diuretics, antihypertensives), consult a doctor to adjust dosing (e.g., taking them at bedtime).