Postural Hypotension
Updated May 01, 2014.
Orthostatic hypotension, also known as postural hypotension, refers to a condition in which blood pressure falls rapidly after a change in body position. Patients with orthostatic hypotension usually experience symptoms of low blood pressure when they stand up after sitting or lying for a period of time. The problem is relatively common, and tends to affect primarily older adults, though younger patients sometimes experience the condition as well.
The diagnosis of orthostatic hypotension requires a blood pressure decline of 20mmHg in the systolic pressure, or 10mmHg in the diastolic pressure, within five minutes of rising from a seated or lying position.
While most people with orthostatic hypotension experience symptoms immediately upon changes in body position, a small number of patients might not have symptoms until 5 to 10 minutes later. This is called delayed orthostatic hypotension, and it is uncommon.
The actual decrease in blood pressure that occurs in orthostatic hypotension can have several different underlying causes, but almost all of these individual causes share the same common effect: They disrupt the normal functioning of the autonomic nervous system, whose job it is to regulate the automatic functions of the body, like breathing and blood pressure. Multiple system atrophy, general dysautonomia, and Lewy body syndromes can all lead to orthostatic hypotension. Rarely, orthostatic hypotension can be caused by other problems like decreased blood volume, certain heart rate disturbances, or failure of the body’s blood pressure sensors.
Several studies have examined the various causes of orthostatic hypotension and have found that nervous system problems are the most common cause. One large review study found that over 60 percent of all orthostatic hypotension cases are caused by some type of problem with the autonomic nervous system, and that the number of cases caused by problems outside of the nervous system is much smaller.
Interestingly, though orthostatic hypotension is usually caused by underlying nervous system problems, it is almost never the first sign of these underlying problems. But because the symptoms are fairly dramatic, it usually marks the first time that patients report a problem to their doctor. Since the particulars of the specific nervous system disease causing the problem vary from person to person, there is no single treatment for orthostatic hypotension. Instead, different types of treatment exist for different patients. Sometimes the solution is as simple as discontinuing a certain medication that may be causing the problem, or increasing fluid intake to replenish blood volume. Other treatment options include:
Even a single episode of fainting after standing up is sufficient reason to schedule a visit to the doctor. In the absence of symptoms that may indicate a more immediate problem like heart attack or stroke, the doctor will likely do a series of tests that may include blood work, a physical exam, and a special test called a tilt test. During a tilt test, you’ll lie on a bed that will change positions and angles. Your blood pressure will be monitored during these changes to assess how serious the problem is. Once symptoms of orthostatic hypotension begin, they tend to worsen over time, so it is beneficial to address the problem as early as possible.
More About Low Blood Pressure:
Sources:
Rutan, GH, et al. Orthostatic Hypotension in Older Adults. The Cardiovascular Health Study. Hypertension 1992; 19:508.
van Lieshout, et al. Physical Manoeuvres for Combating Orthostatic Dizziness in Autonomic Failure. Lancet 1992; 339:897.
Young, TM, Mathias, CJ. The Effects of Water Ingestion on Orthostatic Hypotension in Two Groups of Chronic Autonomic Failure: Multiple System Atrophy and Pure Autonomic Failure. Journal of Neurology and Neurosurgical Psychiatry 2004; 75:1737.
Singer, W, et al. Pyridostigmine Treatment Trial in Neurogenic Orthostatic Hypotension. Arch Neurol 2006; 63:513.
Lee T, Donegan C, Moore A. Combined hypertension and orthostatic hypotension in older patients: a treatment dilemma for clinicians. Expert Reviews of Cardiovascular Therapy. 2005; 433-40.
Sandroni P, et al. Pyridostigmine for treatment of neurogenic orthostatic hypotension - A follow-up survey study. Clinical Autonomic Research. 2005; 51-3.
Frishman WH, Azer V, Sica D. Drug treatment of orthostatic hypotension and vasovagal syncope. Heart Disease. 2003; 49-64.
Orthostatic hypotension, also known as postural hypotension, refers to a condition in which blood pressure falls rapidly after a change in body position. Patients with orthostatic hypotension usually experience symptoms of low blood pressure when they stand up after sitting or lying for a period of time. The problem is relatively common, and tends to affect primarily older adults, though younger patients sometimes experience the condition as well.
The diagnosis of orthostatic hypotension requires a blood pressure decline of 20mmHg in the systolic pressure, or 10mmHg in the diastolic pressure, within five minutes of rising from a seated or lying position.
While most people with orthostatic hypotension experience symptoms immediately upon changes in body position, a small number of patients might not have symptoms until 5 to 10 minutes later. This is called delayed orthostatic hypotension, and it is uncommon.
What causes orthostatic hypotension?
The actual decrease in blood pressure that occurs in orthostatic hypotension can have several different underlying causes, but almost all of these individual causes share the same common effect: They disrupt the normal functioning of the autonomic nervous system, whose job it is to regulate the automatic functions of the body, like breathing and blood pressure. Multiple system atrophy, general dysautonomia, and Lewy body syndromes can all lead to orthostatic hypotension. Rarely, orthostatic hypotension can be caused by other problems like decreased blood volume, certain heart rate disturbances, or failure of the body’s blood pressure sensors.
Several studies have examined the various causes of orthostatic hypotension and have found that nervous system problems are the most common cause. One large review study found that over 60 percent of all orthostatic hypotension cases are caused by some type of problem with the autonomic nervous system, and that the number of cases caused by problems outside of the nervous system is much smaller.
How is Orthostatic Hypotension Treated?
Interestingly, though orthostatic hypotension is usually caused by underlying nervous system problems, it is almost never the first sign of these underlying problems. But because the symptoms are fairly dramatic, it usually marks the first time that patients report a problem to their doctor. Since the particulars of the specific nervous system disease causing the problem vary from person to person, there is no single treatment for orthostatic hypotension. Instead, different types of treatment exist for different patients. Sometimes the solution is as simple as discontinuing a certain medication that may be causing the problem, or increasing fluid intake to replenish blood volume. Other treatment options include:
- Patient education about how to carry and adjust their body positions
- Exercise (in cases caused by a weakened cardiovascular system)
- Medical treatment with agents like fludrocortisone, phenylephrine, or midodrine to adjust both the blood pressure and the function of the nervous system
When to See a Doctor
Even a single episode of fainting after standing up is sufficient reason to schedule a visit to the doctor. In the absence of symptoms that may indicate a more immediate problem like heart attack or stroke, the doctor will likely do a series of tests that may include blood work, a physical exam, and a special test called a tilt test. During a tilt test, you’ll lie on a bed that will change positions and angles. Your blood pressure will be monitored during these changes to assess how serious the problem is. Once symptoms of orthostatic hypotension begin, they tend to worsen over time, so it is beneficial to address the problem as early as possible.
More About Low Blood Pressure:
Sources:
Rutan, GH, et al. Orthostatic Hypotension in Older Adults. The Cardiovascular Health Study. Hypertension 1992; 19:508.
van Lieshout, et al. Physical Manoeuvres for Combating Orthostatic Dizziness in Autonomic Failure. Lancet 1992; 339:897.
Young, TM, Mathias, CJ. The Effects of Water Ingestion on Orthostatic Hypotension in Two Groups of Chronic Autonomic Failure: Multiple System Atrophy and Pure Autonomic Failure. Journal of Neurology and Neurosurgical Psychiatry 2004; 75:1737.
Singer, W, et al. Pyridostigmine Treatment Trial in Neurogenic Orthostatic Hypotension. Arch Neurol 2006; 63:513.
Lee T, Donegan C, Moore A. Combined hypertension and orthostatic hypotension in older patients: a treatment dilemma for clinicians. Expert Reviews of Cardiovascular Therapy. 2005; 433-40.
Sandroni P, et al. Pyridostigmine for treatment of neurogenic orthostatic hypotension - A follow-up survey study. Clinical Autonomic Research. 2005; 51-3.
Frishman WH, Azer V, Sica D. Drug treatment of orthostatic hypotension and vasovagal syncope. Heart Disease. 2003; 49-64.
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