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Understanding Orthostatic Hypotension 

Orthostatic hypotension is low blood pressure when you stand up from sitting or lying down. It can cause symptoms for such as dizziness, lightheadedness, and blurry vision. It may also cause fainting and falls. Sitting or lying down makes the symptoms get better.

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What causes orthostatic hypotension? 

Blood pressure is how much force with which your blood moves through your blood vessels. Hypertension means blood pressure is high. Hypotension means it’s low. Orthostatic means upright posture. Many things can cause blood pressure to be too low when you stand up. 

Some medicines can cause orthostatic hypotension. These include:

  • Blood pressure medicines

  • Water pills (diuretics)

  • Some antidepressants

  • Some heart medicines

  • Some pain, anxiety, sedative, and sleeping medicines 

Other causes include:

  • Eating a large meal

  • Loss of body fluids (dehydration) from vomiting, diarrhea, or not drinking enough

  • Changes in blood vessels because of older age

  • Severe infection

  • High fever

  • Blood loss, such as bleeding from the stomach or intestines

  • Neurological diseases that impair the autonomic nervous system, such as Parkinson disease

  • Congestive heart failure

  • Diabetes

  • Alcoholism

  • Peripheral neuropathy 

Symptoms of orthostatic hypotension 

Symptoms happen when you stand up from sitting or lying down. They can also happen after standing for a long time. They can include:

  • Feeling lightheaded

  • Feeling dizzy

  • Weakness

  • Blurred vision

  • Tunnel vision

  • Pain in the back of head, neck, and shoulders

  • Fainting 

The symptoms get better or go away when you sit or lie down. 

Diagnosing orthostatic hypotension 

Your healthcare provider will ask about your symptoms and health history. Make sure to tell him or her every medicine that you take. This includes over-the-counter supplements, vitamins, and herbs. Also tell your healthcare provider if you have been sick recently. 

You may also have tests such as:

  • Blood pressure test. Your healthcare provider will measure your blood pressure while sitting and when standing up.

  • Blood tests. These check for illness or other conditions that may cause the problem.

  • Electrocardiogram (ECG). This test looks at the electrical activity of your heart.  

Treatment for orthostatic hypotension 

Treatment may depend on what's causing your low blood pressure. It can include any of these:

  • Stopping medicines that may be causing symptoms

  • Standing up slowly

  • Not spending time in hot weather

  • Drinking plenty of fluids

  • Eating more salt

  • Drinking less alcohol 

In some cases, your healthcare provider may prescribe a medicine to help prevent orthostatic hypotension. Talk with your healthcare providers about the risks, benefits, and possible side effects of all medicines. 

Possible complications of orthostatic hypotension 

The condition can cause falls, especially in older adults. Falls can lead to injury and time in the hospital. People with orthostatic hypotension may also have a higher risk for future heart problems. These include congestive heart failure and heart rhythm problems. In some cases, it can cause stroke. 

Living with orthostatic hypotension 

Change positions slowly from lying to standing. When getting out of bed, sit on the side of the bed with your legs down for at least 30 seconds before standing. This gives your body time to adjust to the position change. 

When to call your healthcare provider 

Call your healthcare provider if you have any of the following:

  • Dizziness, lightheadedness, or fainting

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Symptoms that don’t get better, or get worse

  • Black or red color in your stools or vomit

  • Diarrhea or vomiting that doesn’t stop

  • Inability to eat or drink

  • Burning when you urinate

  • Foul-smelling urine

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