Postural Hypotension

Ipswich Hospital
Frailty Assessment Base
Tel: 01473 702 263

What is postural hypotension?

Postural hypotension, also known as orthostatic hypotension, is a fall in blood pressure which often occurs when a person changes their body position (posture), typically from lying to standing or sometimes sitting. It is a common problem affecting older people but it can affect younger people too.
Postural hypotension can result in a decreased blood flow to the brain, causing a sensation of dizziness or light-headedness, and sometimes falls or blackouts.

What causes postural hypotension?

There are several causes of postural hypotension. It can be due to several causes in one person. It is more common in older people, especially in people with conditions such as diabetes and Parkinson’s disease. However, it can occur in almost anyone. It can be caused by:

  • not drinking enough fluids or being dehydrated
  • overheating – after a hot bath, being in a hot room or outside on a sunny day
  • illness, such as a cold or infection
  • anxiety or panic – this can cause you to change your normal breathing pattern
  • anaemia
  • mobilising after a period of prolonged bed rest; and
  • certain medications – taking too many ‘water tablets’ (diuretics) causing you to become dry or dehydrated, having too much medication for high blood pressure (anti-hypertensives), or medication for specific conditions, for example Parkinson’s disease.

What are the symptoms of postural hypotension?

A fall in blood pressure leads to a reduced blood supply to the brain, other organs and muscles, which can cause a variety of symptoms including:

  • feeling dizzy or light-headed particularly on standing up
  • feeling confused or muddled
  • losing consciousness with or without warning – this is a ‘faint’ or a ‘blackout’
  • change in your vision such as blurring, greying or darkening vision
  • weakness and fatigue
  • pain across the back of your shoulders and neck; and
  • pain across your lower back and buttocks.

These symptoms can vary from person to person.  It is important to note that not everyone will experience symptoms. 40% of people with postural hypotension will have no symptoms at all – sometimes a fall is the first sign of a problem.

When are the symptoms likely to happen?

When there is an increased demand for the blood circulating in the body, for example:

  • moving – standing or sitting up suddenly
  • in the morning – blood pressure is naturally lower first thing in the morning
  • during exercise – exercise and activity of any kind (including housework) increases the demand for blood for the muscles
  • after meals – blood is needed by the digestive system, particularly after a large meal, sugary food or alcohol
  • straining – if you are constipated or are having difficulty passing urine

What to avoid to help reduce the symptoms?

Avoid becoming dehydrated and try to drink 3-and-a-half pints (two litres) of fluid, preferably water, every day. Drink a large glass of water before getting out of bed in the mornings. But do not do this if you have been advised by your doctor to limit your fluid intake.

Other ways to help with the symptoms:

  • avoid getting up quickly or hurrying
  • avoid standing/sitting still for long periods of time
  • avoid bending at the waist or stretching up if possible. If you drop something on the floor, squat down to recover it
  • avoid excessive alcohol
  • avoid large meals
  • avoid overheating, such as having very hot baths or getting over heated in a very warm room
  • avoid becoming constipated and ensure that your diet is high in fibre.

What you can do to help reduce the symptoms?

  • Do stand/ get up slowly, especially when you first wake up or have been sitting down for a long period.
  • Do rise slowly when getting out of bed. Sit with your legs hanging down for a few minutes before standing. Make sure that your balance is steady before walking.
  • Do try clenching and unclenching your calf muscles before standing/moving.
  • Do plan your day ahead and sit down for tasks such as preparing meals/vegetables or getting dressed.
  • Do eat little and often.
  • Do reduce the amount of carbohydrates you eat at meal times.
  • Do try sleeping with the head of your bed raised five inches above the horizontal position.
  • Do ask your doctor or pharmacist if any new medication you are taking is likely to affect your blood pressure.
  • Do ask your doctor to assess your bone health as postural hypotension can make you more prone to falls and you may benefit from medication which can strengthen your bones.

What should you do if you get symptoms?

Think of the symptoms as a warning that your blood pressure is too low. The way to improve your symptoms and maintain your safety is to:

  • stop what you are doing
  • sit down or lie down
  • drink a glass of water
  • think about what could have triggered your symptoms

If you have frequent symptoms, you should contact your GP for further advice. This may include further investigations of your symptoms including medication review and lying/standing blood pressure monitoring.
Do not stop taking any medication without discussing this first with your doctor.

What treatments are available?

Your doctor can:

  • review and if necessary try to limit the amount of blood pressure/heart medications
  • prescribe leg compression stockings if appropriate
  • prescribe tablets to increase your blood pressure and avoid salt loss, if appropriate.

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