Postural Hypotension

This leaflet tells you about Postural Hypotension and the symptoms you might experience. There are also some treatments that may help.

What is Postural Hypotension?

Postural Hypotension or Orthostatic Hypotension means that your blood pressure drops when there is a change in position, for example from lying to standing up.

When we sit or lie down, the blood pools in our legs. Usually, your body will adjust for the change in position and increase the blood pressure.

If you have postural hypotension, the body is slower to push blood back up to the brain when you stand. Some people have symptoms due to this drop in blood pressure.

What symptoms might I experience?

• Light-headedness or dizziness
• Weakness and tiredness
• Blurred vision
• Feeling sick
• Feeling warm
• Feeling of sweatiness or clamminess
• Feeling as though you might faint
• Fainting

Some people have very few symptoms of their postural hypotension and it may simply make you more unsteady on your feet.⁴

How does my doctor diagnose postural hypotension?

Your doctor can confirm that you have postural hypotension based on the symptoms you describe and the pattern of when those symptoms happen.²

Your doctor may do some basic tests like blood tests and an ECG (tracing of the rhythm of your heart). They can confirm the diagnosis by checking your blood pressure and heart rate when you are sitting, then standing up at 1 minute and 3 minutes.

Sometimes your doctor may send you to get further tests on a Tilt table. A Tilt table is a special bed or table that you lie on which can then be moved to different angles while your blood pressure is checked.

What might increase the chance of having postural hypotension?

• Increased age
• Prolonged bed rest
• Prolonged standing 
• Eating large meals 
• Exposure to heat 
• Drinking alcohol
• Not eating or drinking regularly
• Lack of regular exercise 
• Varicose veins
• Anaemia
• Diabetes
• Parkinson’s disease¹
• Some medications*

*Do not stop taking any medications without discussing this with your doctor first.

What will help make postural hypotension better? ^2,3

Do

• Drink regular fluids through the day aiming for around 2 to 3 litres a day.**
• Eat salty snacks.**
• Be careful first thing in the morning – symptoms are often worst at this time. Have a glass of water beside your bed to drink before you get out of bed.
• Eat multiple small meals rather than one large meal.
• Move and/or exercise regularly.
• Change position from lying to sitting or sitting to standing slowly.
• Try counter pressure manoeuvres (listed further in this leaflet) to help.

**Do not do this if you have a history of heart failure. Discuss this with your GP or health care provider.

Avoid (any of these can cause worsening of low blood pressure)

• Sudden changes in position
• Prolonged standing
• Dehydration (not drinking enough)
• Drinking alcohol
• Straining e.g. heavy lifting or with constipation
• Over heating

What to do when you get symptoms

Think what symptoms warn you that your blood pressure may be low.

STOP what you are doing

SIT down or lie down

DRINK some water

What are counter pressure manoeuvres?

Techniques that help the blood flow back to your brain.

Try:

Clenching and unclenching your fists

Squeezing the muscles in your legs and buttocks

Crossing and uncrossing your legs

When you feel recovered, try to get moving again but take your time and try some of the movements suggested above.

If you still feel unwell speak to your GP, or call 111.

What extra things may my doctor recommend?

Your doctor will review your medications with you to make sure you are taking the best tablets for you, at the correct dose and see if anything can be stopped.

If it is appropriate for you, your doctor may suggest trying compression stockings or a medical corset. These are firm, but not tight fitting, long socks that help squeeze the legs so that the blood does not pool in your legs.

Sometimes in very severe cases, your doctor may suggest trying some medication to help with very bad symptoms from postural hypotension. ^2,3

With care and by working with your GP your symptoms can normally be managed well.

Further Information

Patient UK

https://patient.info/heart-health/low-blood-pressure

Patient UK is a website that gives information and advice about health conditions. The information is reviewed by healthcare professionals and follows the NHS Standard for Creating Health Content

References

1. Fanciulli A, Leys F, Falup-Pecurariu C, et al; Management of Orthostatic Hypotension in Parkinson’s Disease. J Parkinsons Dis. 2020;10(s1):S57-S64.

• Palma JA, Kaufmann H; Management of Orthostatic Hypotension. Continuum (Minneap Minn). 2020 Feb;26(1):154-177.

• Dani M, Dirksen A, Taraborrelli P, et al; Orthostatic hypotension in older people: considerations, diagnosis and management. Clin Med (Lond). 2021 May;21(3):e275-e282.

• Fedorowski A, Melander O; Syndromes of orthostatic intolerance: a hidden danger. J Intern Med. 2013 Apr;273(4):322-35.

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