Orthostatic hypotension is a drop in blood pressure of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing. It is common in older adults, is often caused by dehydration, medicines or nerve damage, and raises the risk of falls.
Key symptoms
- Dizziness or lightheadedness on standing
- Blurred or dimmed vision
- Weakness, fatigue or trouble thinking
- Fainting or falls, often in the morning or after meals
What you find on exam
- Orthostatic vitals: lying for 5 minutes, then standing at 1 and 3 minutes
- Heart rate response: little rise suggests nerve failure, a large rise suggests low volume
- Signs of dehydration or bleeding
- Neurologic exam for Parkinson disease or neuropathy
Tests
- Medication review: diuretics, alpha blockers, nitrates, antidepressants
- Blood count, electrolytes, glucose, kidney function
- ECG for arrhythmias
- Tilt table or autonomic testing if the cause is unclear
Treatment basics
- Stop or reduce culprit medicines
- Fluids, more salt if safe, compression stockings
- Stand up slowly; cross the legs and tense muscles when dizzy
- Midodrine, fludrocortisone or droxidopa for persistent symptoms
Red flags
- Fainting with chest pain or palpitations
- Signs of internal bleeding
- Injury from a fall
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Related guides
Sources: CDC STEADI (falls in older adults); NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.