Orthostatic Hypotension (Low Blood Pressure When Standing)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideLow Blood Pressure (Hypotension): Symptoms, Signs, Causes

Low Blood Pressure (Hypotension): Symptoms, Signs, Causes

When should I call the doctor for orthostatic hypotension?

Feeling faint or lightheaded is not normal. While a rare episode that can be explained by circumstances, such as working or exercising in the heat, may be ignored, more frequent occurrences should be investigated.

If a person passes out and is unconscious, even for a short period of time, is never normal and medical care should be accessed.

How is orthostatic hypotension diagnosed?

The key to the diagnosis is a good history and physical examination. The health care practitioner will want to know the circumstances that are associated with the symptoms of lightheadedness or passing out, since the patient is unlikely to have taken their blood pressure and checked their pulse rate in the midst of the episode.

The symptoms tend to be transient and resolve quickly. Should there be concern that the vital signs will change with position, the health care practitioner will take the blood pressure in both lying and standing positions and look for changes. It is advisable to pump up the cuff first, then have the patient stand, and then begin to release the pressure.

According to the American Academy of Neurology, the formal diagnosis of orthostatic hypotension requires a 20mm drop in systolic blood pressure or a 10mm drop in diastolic blood pressure within three minutes of standing. Often there is an associated increase in the heart rate, especially if dehydration or bleeding is the cause (if the patient is taking a beta blocker, the heart rate may not be able to respond with an increase).

Blood tests may be ordered to look for the underlying cause. These may include a red blood cell count (CBC) to access for anemia or bleeding. Electrolytes may be checked, especially if there has been a history of fluid loss through vomiting or diarrhea, since sodium and potassium abnormalities may be an issue. Kidney function may be assessed.

If the physical examination reveals concern about the heart, an electrocardiogram (EKG) may be done to evaluate electrical conduction and heart rhythm. An echocardiogram or ultrasound of the heart may be ordered to evaluate the heart valves and assess the function of the heart muscle. A stress test may be considered if there is concern about coronary artery disease.

A heads-up tilt table test may be ordered if the symptoms of orthostatic hypotension continue to recur but it has been difficult to document abnormalities in blood pressure readings. During the test, the patient is strapped flat on a table, and as the table gradually is tilted to a 70 or 80 degree angle, continuous blood pressure and heart rate readings are taken. The patient may be left on the table for more than 10 minutes to look for the delayed changes seen in postural orthostatic tachycardia syndrome.

For many patients, the diagnosis may be made based upon the history and physical examination, and no further testing may be needed.

Medically Reviewed by a Doctor on 1/13/2017

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