Heart Health: 10 Essential Facts About Orthostatic Hypotension

orthostatic hypotension
By Mark Henricks, reviewed by Michael Cutler, DO, PhD
Published by EveryDayHealth.com
This article includes excerpts from interviews with Dr. Guy Mayeda.

That spinning feeling when you stand up probably means your blood pressure just dropped.

Maybe this has happened to you: You’re getting out of bed or rising from a chair and unexpectedly feel dizzy or lightheaded.

Your vision may dim or blur or you could have tunnel vision. To add to this already frightening experience, you may also feel confusion and dizziness. Less commonly, you could have dull pain across the back of your neck and shoulders. Rarely, you could lose consciousness or faint.

These are symptoms of a condition called orthostatic hypotension, which results when blood pressure drops excessively due to a change in position.

Who can have orthostatic hypotension? It is very common, especially among older people, affecting approximately 18 percent of those over 65, notes a 2011 review in American Family Physician. It becomes even more prevalent as people age, with up to half of elderly people living in institutions, such as nursing homes, meeting the definition for orthostatic hypotension, according to a 2013 position paper in Journal of Clinical Hypertension.

Does orthostatic hypotension go away? Typically, yes, an episode of hypotension ends quickly; once you sit or lie down, symptoms disappear. The biggest risk for most people who have orthostatic hypotension is injury from a fall. But if you have chronic or recurrent orthostatic hypotension, it may indicate a more serious underlying condition.

Here are 10 essential facts about orthostatic hypotension:

1. Most Episodes of Orthostatic Hypotension Go Unnoticed

2. Gravity Is the Basic Culprit
What causes orthostatic hypotension? When you’re lying down, your blood is evenly distributed throughout your body. When you stand up, gravity causes blood to pool in your legs. “Normally, blood vessels in the lower body constrict when we stand up — also known as vasoconstriction — to prevent the blood pressure from dropping too much as we change position,” explains Guy Mayeda, MD, a cardiologist at Good Samaritan Hospital in Los Angeles. If this compensation fails to occur rapidly enough or strongly enough, blood flow to your brain can decrease and become briefly starved of oxygen. The brain is extremely sensitive to low oxygen levels, and that leads to dizziness and other symptoms.

3. Orthostatic Hypotension Usually Resolves Quickly

4. Age Is One of the Biggest Risk Factors for Orthostatic Hypotension

5. Dehydration Is One of the Most Common Causes

6. Orthostatic Hypotension Particularly Affects Healthy Exercisers

7. You Should See Your Doctor if You Have an Episode
Although orthostatic hypotension is rarely harmful, consider making a doctor’s appointment if you experience it for the first time. “It should be taken seriously because studies have shown that people with orthostatic hypotension are at higher risk of developing cardiovascular problems in the future,” says Kristine Arthur, MD, an internist at Orange Coast Memorial Medical Center in Fountain Valley, California. There is a link between orthostatic hypotension and increased risk of congestive heart failure, Arthur adds. Orthostatic hypotension could also be a sign of other aliments, including diabetic neuropathy, thyroid problems, and Parkinson’s disease.

8. Diagnosis Is Quick, Simple, and Painless

9. A Variety of Treatments Work for Orthostatic Hypotension

10. Behavior Modification Is Often the Best Treatment
How can you prevent orthostatic hypotension? Simply pausing for a minute before rising from bed can significantly reduce episodes of orthostatic hypotension, because this allows your cardiovascular system to adjust. This is especially relevant when you’ve been sleeping and are getting up in the middle of the night. Here are other ways to reduce the number or risks of orthostatic hypotension episodes:

  • Keep one hand on a rail or support when rising.
  • Be ready to sit or lie back down quickly if symptoms begin.
  • Stay hydrated.
  • Take medications at bedtime.
  • Your doctor may also recommend wearing compression socks to reduce blood pooling in your legs.

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