Orthostatic Hypotension

Symptoms include:

Lightheadedness
Disequilibrium
Blurred vision or “browning-out”
Weakness
Fatigue
Cognitive impairment
Syncope (fainting)

Improvement is typically seen when returning to sitting, lying down, or standing with support.

Causes of Orthostatic Hypotension

Orthostatic hypotension can stem from neurogenic and non-neurogenic origins:

Neurogenic causes:

Peripheral neuropathy (e.g., diabetes, autoimmune diseases)
Parkinson’s disease
Multiple system atrophy
Pure autonomic failure
Lewy body dementia
Multiple sclerosis
Postural orthostatic tachycardia syndrome (POTS)

Non-neurogenic causes:

Cardiac impairment (e.g., myocardial infarction, aortic stenosis)
Dehydration
Adrenal insufficiency
Vasodilation (e.g., fever)
Medications like diuretics, alpha-blockers for BPH, antihypertensives, and calcium channel blockers

Diagnosing Orthostatic Hypotension

Diagnosis involves a tilt test or a tilt table test, monitoring blood pressure and heart rhythm from lying to standing positions, identifying significant changes that confirm orthostatic hypotension.

Managing Orthostatic Hypotension

Management aims at elevating standing blood pressure without adversely affecting supine blood pressure, focusing on reducing symptoms and improving daily activity tolerance. Strategies include:

Abdominal compression and compression stockings
Boluses of water for rapid symptom relief
Bed elevation to mitigate morning symptoms
Countermaneuvers like leg crossing and thigh muscle contraction
Medication adjustments, considering fludrocortisone and midodrine
Education on symptom triggers and management
Exercise, favoring mild, recumbent activities
Fluid and salt intake adjustments for optimal plasma volume

How we evaluate it

Testing is chosen from your history and examination. These are the tests most often used for this condition.

Tilt Table TestingTracks blood pressure and heart rate as the body is tilted upright, to evaluate lightheadedness and fainting.

Learn more

Parkinson's DiseaseParkinson's Disease (PD) is a progressive neurological disorder that affects movement, causing symptoms that worsen over time.Orthostatic HypotensionOrthostatic hypotension represents a significant drop in blood pressure upon standing, often observed in elderly patients.Cardiac ArrhythmiasCardiac Arrhythmias occur when there's a disruption in the heart's electrical system, leading to irregular heartbeats.DizzinessDizziness can mean spinning (vertigo), lightheadedness, or unsteadiness, and each points toward different causes.

Care approach

Care plans are individualized. The practice combines detailed history, bedside examination, and targeted testing to decide whether treatment should focus on vestibular rehabilitation, migraine or medication management, canalith repositioning, cardiovascular coordination, neurologic treatment, or additional specialty referral.