Have you ever felt lightheaded or dizzy after getting standing up? These symptoms may be a sign of orthostatic hypotension, or low blood pressure due to positional changes. If you suspect you have orthostatic hypotension, or have been told that you do, here is what you can do.

Knowing the Symptoms

  • Lightheadedness
  • Dizziness
  • Weakness
  • Difficulty thinking
  • Headache
  • Feeling faint

Taking your own blood pressure

There are many benefits to knowing your blood pressure readings.

  • Allows you to take control of your health care by being aware of changes that may alert you to consult with your doctor.
  • Can help you detect sudden drops in blood pressure that may be due to factors such as side-effects from medications.
  • May help save in overall healthcare costs via prevention of diseases

While there may be many factors may prohibit taking blood pressure readings at home, the one common factor may be access and cost. The cost of an automatic blood pressure machine has been going down and can be purchased for around $30.

An important step after acquiring a new blood pressure machine is making sure it is calibrated correctly. Prior to discharge from the hospital, have your nurse calibrate your blood pressure monitor and compare it to the hospital’s. Consider bringing in your automatic blood pressure machine into your next check-up for comparison.

Getting in the habit

Take your blood pressure often. Two times should be enough. Take one in the morning before taking any medications and one in the evening. Your doctor may want you to take your blood pressure at the same times each day. Keep a diary of your blood pressure after taking it and write it down. This allows you to see trends based on behaviors. Some machines may save blood pressure values into its memory bank

Blood Pressure Values

Every individual varies in their blood pressure for what may be their baseline. The average value is considered 120/80. Your numbers may run lower, even at rest. What is more important is the decrease in blood pressure when standing up. Take an initial blood pressure in sitting, then after a few minutes, take another reading. If you feel lightheaded or dizzy, consider sitting down.

A 20 point drop in the top number or 10 point drop in the bottom number is considered orthostatic hypotension

What Happens When We Stand Up?

When we stand up, gravity acts on your blood and creates a fluid shift on your body. This results in a decrease in blood return, heart output, and therefore a decrease in blood pressure. Orthostatic hypotension may have several causes:

  • Diabetic Neuropathy
  • Autoimmune conditions
  • Parkinson’s Disease
  • Body Atrophy
  • Cardiac conditions (heart attack, aortic stenosis)
  • Dehydration
  • Fever
  • Common drugs
    • Diuretics
    • Alpha-adrenoceptor blockers
    • Antihypertensive drugs
    • Calcium channel blockers
    • Insulin
    • Levodopa
    • Tricyclic antidepressants
  • Older age – in general, orthostatic hypotension is more common in the elderly.

Other conditions that may exacerbate orthostatic hypotension include:

  • Dehydration
  • Time of day (early morning)
  • Rising quickly after prolonged sitting
  • Prolonged standing without motion
  • Physical exertion (vigorous exercise)
  • Alcohol
  • Carbohydrate-heavy meals
  • Heat exposure
  • Straining during urination or having a bowel movement

Management – from A to F

A = Abdominal compression

Wear an abdominal binder when out of bed

A = Avoid crossing your legs when sitting

A = Avoid standing up quickly

B = Bolus of water

Drink two 8-ounce glasses of cold water prior to prolonged standing

B = Bed up

Sleep with head of bed elevated

C = Contract

Contract your muscles below your waist for about half a minute

  • Toe-raising

  • Leg-crossing and contraction

  • Thigh muscle co-contraction

  • Bending at the waist

  • Slow marching in place

  • Leg elevation

D = Drugs

Recognize that some drugs may decrease your blood pressure

Talk to your doctor about taking drugs that help to raise your blood pressure

E = Education

Recognize the conditions that lower your blood pressure such as heavy meals, positional changes, heat, hot baths, or exercise

Learn the “A-F’s of orthostatic hypotension”

F = Fluids and salts

Talk to your dietician about how fluids and salt (10 to 20 g per day) may help

 


References:

Figueroa, J. J., Basford, J. R., & Low, P. A. (2010). Preventing and treating orthostatic hypotension: as easy as A, B, C. Cleveland Clinic journal of medicine77(5), 298.