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Am Fam Physician. 2022;105(1):online

See related article on orthostatic hypotension

What is orthostatic hypotension?

Orthostatic hypotension (ORTH-oh-sta-tik HI-po-TEN-shun) happens when your blood pressure drops right after you sit up or stand. This can make you feel dizzy, like you are about to pass out, or have blurred vision. You may feel weak or sick to your stomach, or have chest pain or trouble breathing. These symptoms go away when you lay down.

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. Sometimes this process doesn't work, causing orthostatic hypotension. Medication side effects or not getting enough water are some common causes. This can also happen in people with diabetes, Parkinson disease, or a nervous system disorder.

What should I do if I think I have it?

Tell your doctor. Your symptoms could be a sign of a more serious medical problem. Your doctor will check your blood pressure when you are lying down or sitting up, and then again when you stand. Your doctor will ask about your medical history, check the medicines that you are taking, and do a physical exam. You may need other medical tests. Your doctor may send you to see 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.

  • Do not stand for long periods of time.

  • Avoid hot and humid conditions or long, hot showers.

  • Eat five to six small meals per day instead of three large meals.

  • Stay physically active with a gentle exercise program.

Other things that could help are compression stockings, drinking more water, and taking salt pills, but talk to your doctor first. If you still have symptoms, your doctor may prescribe medicine.

Where can I get more information?

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