Orthostatic Hypotension: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Orthostatic Hypotension?
A primary care doctor, such as a family doctor, often diagnoses and treats orthostatic hypotension. A cardiologist, a heart doctor, or a neurologist, a nerve doctor, may help find the cause. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is orthostatic hypotension?
Orthostatic hypotension is a drop in blood pressure that happens when a person stands up. It is also called postural hypotension. Doctors define it as a drop of 20 points or more in the top blood pressure number, or 10 points or more in the bottom number, within three minutes of standing. Some people have no symptoms at all.
Normally, gravity pulls blood down into the legs when you stand. The nervous system tells blood vessels to narrow and the heart to beat faster. When this fix does not work well enough, blood pressure falls.
Symptoms
Common symptoms include:
- Dizziness or lightheadedness.
- Weakness, or legs that buckle.
- Nausea.
- Blurry vision.
- Tiredness and headaches.
Some people have a temporary loss of consciousness, called syncope, which is a faint or blackout. Symptoms usually last only a few seconds or minutes. If you have symptoms, sit or lie down right away. Symptoms are often worse in the morning, and heat can make them worse. Falls are a serious risk, because they can cause a broken hip or other broken bones.
Causes and who gets it
There are many different causes. Sometimes the cause is never found. A common cause is a drop in blood volume, which can come from excessive use of water pills, called diuretics. Other causes include:
- Medicines that widen blood vessels, such as some used for high blood pressure, heart failure, or chest pain.
- Some antidepressant and antipsychotic medicines.
- Alcohol.
- Dehydration, long-term bleeding, diarrhea, or long-term vomiting.
- Heart problems, such as a heart rhythm disorder or a heart attack.
- Nervous system diseases, such as Parkinson's disease or multiple system atrophy.
- Nerve damage from diabetes.
- Long bed rest.
It is most common in older adults, new mothers after childbirth, people who have been on bed rest, and teenagers.
How doctors diagnose it
Doctors check your blood pressure and heart rate after you lie flat for five minutes, and again three minutes after you stand. A significant fall in blood pressure during this test points to orthostatic hypotension. A tilt table test may be used in unclear cases or when you cannot stand safely. You lie on a table that tilts you upright. Your provider will ask what medicines you take and whether you feel dizzy when you stand. Blood tests and an ECG, a heart rhythm test, can look for causes such as anemia, thyroid problems, or an abnormal heart rhythm.
Treatment
The goals are to ease symptoms and improve quality of life, rather than to make blood pressure normal. Care starts with finding and treating the cause. If a medicine is the cause, your provider may adjust it. Do not stop taking any medicine before talking to your provider. Steps you can take include:
- Rise slowly when you get up from a chair or bed.
- Drink plenty of fluids and, if your doctor agrees, add salt. Both help the body keep enough blood volume.
- Ask your doctor first if you have heart failure, cirrhosis, or chronic kidney disease, because extra fluid and salt can carry risks.
- Wear compression stockings, which help keep blood from collecting in the legs.
- Limit alcohol and large meals heavy in carbohydrates.
- Avoid hot baths and long walks in hot weather.
- Raise the head of your bed, which helps some people.
- Do exercises that strengthen the legs. Some programs teach moves such as toe raises, leg crossing, and bending over at the waist.
If these steps are not enough, medicine may be added. The FDA has approved midodrine and droxidopa for orthostatic hypotension. Both can cause high blood pressure when lying down, so they should be avoided near bedtime.
When to see a doctor
Call 911 or go to the emergency room if you have chest pain, trouble breathing, or black or maroon stools, or if low blood pressure makes someone pass out. Call your provider right away if you have an irregular heartbeat. If the person is not breathing or has no pulse, begin CPR.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This type of doctor can check your blood pressure, review your medicines, and refer you to a heart or nerve specialist when needed.
Common questions
Why does blood pressure drop when you stand up?
Gravity pulls blood down into the legs and trunk when you stand. Normally the nervous system narrows blood vessels and speeds up the heart to make up for this. In orthostatic hypotension, that response does not work well enough.
Is orthostatic hypotension serious?
It can be. A serious complication is the risk of falling, which can lead to a broken hip or other broken bones.
Can dehydration cause orthostatic hypotension?
Yes, it can. Dehydration lowers blood volume, and the body then cannot make up for the drop in pressure when you stand.
Should I stop my medicine if I feel dizzy when I stand up?
No, do not stop any medicine without talking to your provider first. Some medicines can cause orthostatic hypotension, and your provider may change the dose or switch you to a different medicine.
Sources
- MedlinePlus - Low blood pressure
- National Organization for Rare Disorders - Orthostatic Hypotension
- American Academy of Family Physicians - Orthostatic Hypotension: A Practical Approach
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
