Orthostatic Hypotension


  • Very common- around 20% of people over the age of 65 living in the community (this doubles when looking at people in care)


  • It is more common amongst older people for a number of reasons:
    • baroreceptor responses diminish with age
    • long-standing hypertension can also diminish this response; also long-standing vascular disease makes the vessels less likely to respond (less pliable)
      • Elderly patients are also more likely to have an isolated systolic hypertension
        • Whilst this carries a similar cardiovascular risk as generic hypertension, it means that the mean arterial pressure can be significantly low- particularly at the head with gravity
    • cerebral autoregulation is also often poorer in the elderly population
    • elderly patients are also much more likely to be on a number of medications that could cause orthostatic hypotension
  • It is important to remember that, like falls, orthostatic hypotension is a symptom which has a cause.  Changes due to aging may be the cause, but others should be looked for.
    • Drugs are the most common cause
    • Drugs that can decrease blood pressure or exacerbate orthostatic hypotension
      Drugs that can decrease blood pressure or exacerbate orthostatic hypotension


  • Other diseases that cause OH include
    • Diabetes; parkinson’s; addison’s; heart failure; heart valve disorders; GI bleed
  • Other causes include dehydration, physical exertion, post-prandial


  • A drop of >20mmHg SBP or >10mmHg DBP between sitting/lying and standing blood pressures (after 3 mins)


  • Typically patients will report feeling light-headed, dizzy and/or nauseous on standing up (from lying/sitting).  They may or may not fall.  The feeling should resolve after a few minutes (or with returning to sitting/lying position).


  • Lying/standing blood pressure
  • U&Es (hydration status)


  • Most commonly- elimination of the causal drug
    • HOWEVER, treatment of hypertension is thought to be beneficial for patients with orthostatic hypotension.  Complete removal of antihypertensive medication is not recommended.
  • Correct any underlying causes
  • Fluid and salt intake should (usually) be maximised and sleeping with the head raised
  • In severe cases which a) do not have an underlying cause and b) cannot be controlled: drug treatment (midodrine (unlicensed) or fludrocortisone) may be used

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: