Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure quickly decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.
As you stand, blood falls toward your lower body in response to gravity. To help keep blood in the upper body:
Blood pressure is also affected by the amount of blood in the blood vessels. Low levels of blood will decrease the blood pressure and make it harder for the body to compensate when you stand. Low blood volume, called hypovolemia, is the most common cause of orthostatic hypotension. It may be due to:
Orthostatic hypotension will occur when 1 or more of these factors do not work as expected. It may be associated with:
Factors that increase your chance of orthostatic hypotension include:
Orthostatic hypotension may cause:
Exercise or having eaten a heavy meal may worsen symptoms.
Orthostatic hypotension is diagnosed when symptoms are present and there is a measured reduction in blood pressure while standing, which is relieved by lying down.
When possible, treatment will focus on resolving the orthostatic hypotension completely. If a complete resolution is not possible, treatment will focus on managing symptoms.
Treatment will depend on the cause. Examples include:
Common approaches include:
The doctor may recommend prescription medications to increase blood pressure.
Dietary changes may also help increase blood pressure or prevent very low blood pressure. A dietitian may help create a diet plan. Steps may include:
Behavioral changes that may help include:
National Institute of Neurological Disorders and Stroke
National Organization for Rare Disorders
Heart and Stroke Foundation
Berkow R, Beers MH, eds. The Merck Manual of Medical Information—Home Edition. 2nd ed. Simon and Schuster, Inc; 2003.
Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 8th ed. St. Louis, MO: Mosby; 2006.
Goldman L. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: Saunders; 2004.
Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: Diagnosis and treatment. Am J Med. 2007;120:841-847.
Lenders JW, Eisenhofer G, et al. Phaeochromocytoma. Lancet. 2005;366:665-675.
National Institute of Neurological Disorders and Stroke website (NINDS) orthostatic hypotension information page. Available at: http://www.ninds.nih.gov/disorders/orthostatic_hypotension/orthostatic_hypotension.htm. Updated September 30, 2011. Accessed August 21, 2014.
Orthostatic hypotension and orthostatic syncope. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114777/Orthostatic-hypotension-and-orthostatic-syncope. Updated February 1, 2016. Accessed September 23, 2016.
Shibao C, Grijalva CG, et al. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120:975-980.
3/24/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114777/Orthostatic-hypotension-and-orthostatic-syncope: Mills PB, Fung CK, et al. Nonpharmacologic management of orthostatic hypotension: A systematic review. Arch Phys Med Rehab. 2015;96(20):366-375.
Last reviewed September 2016 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.