10th May 2025

Orthostatic hypotension

Orthostatic hypotension is a condition in which a person’s blood pressure (BP) drops abnormally when they stand up after sitting or lying down.

Diagnostic criteria

Abnormal BP fall is defined as a progressive and sustained fall in systolic BP from baseline value ≥ 20mmHg or diastolic BP ≥ 10 mmHg, or a decrease in systolic BP to < 90 mmHg.

Table 2: Causes of orthostatic hypotension

Management

• Explanation of the diagnosis, reassurance, and avoidance of triggers
• Adequate hydration and salt intake
• Modification and discontinuation of hypotensive drug regimens 
• Isometric physical counterpressure maneuvers if symptoms persist
• Abdominal binders/ support stockings to reduce venous pooling if symptoms persist
• Midodrine (2.5-10mg t.i.d) if symptoms persist
• Fludrocortisone (0.1-0.3mg once daily) if symptoms persist
• Head-up tilt sleeping (>10 degrees) to increase fluid volume if symptoms persist.