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Am Fam Physician. 2011;84(5):537

See related article on orthostatic hypotension.

What is orthostatic hypotension?

Orthostatic hypotension (ORTH-oh-sta-tik HI-po-TEN-shun) happens when sitting up or standing causes your blood pressure to drop. This may cause symptoms such as blurred vision, dizziness, or feeling like you are about to pass out. You also may feel weak or sick to your stomach, or have chest pain or trouble breathing.

What causes it?

Normally when you sit up or stand, your blood moves to your legs and away from your heart and brain. When this happens, your leg muscles squeeze blood back to the heart, and your heart works harder to pump blood to the brain. Certain things may cause this process to fail, causing orthostatic hypotension. This can happen in people with diabetes, Parkinson disease, or a nerve disorder called dysautonomia (DIS-aw-toh-NO-me-uh). Some types of medicines or dietary supplements also may cause it.

What should I do if I think I have it?

Tell your doctor. Your symptoms may be a sign of a more serious medical condition. Your doctor will check your blood pressure when you are lying down or sitting up, and then again once you have been standing. He or she will ask about your medical history, check your medicines, and do a physical exam. You also may need other medical tests. Your doctor may refer you to a heart or nervous system specialist.

How is it treated?

There are things you can do to help:

  • Move slowly when sitting up or standing after lying down.

  • Avoid standing for long periods of time. If you must stand for a long time, squeezing and relaxing your calf muscles can help.

  • Drink six to eight cups of water each day.

Your doctor may recommend compression stockings or salt supplementation, but do not increase your salt intake without asking your doctor. If you still have symptoms, your doctor may prescribe medicine.

Where can I get more information?

Your doctor

Dysautonomia Foundation, Inc.

Dysautonomia Information Network

National Dysautonomia Research Foundation

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