Dizziness When Standing: Understanding and Managing Postural Blood Pressure Changes
Dizziness when standing up occurs because gravity pulls blood downward during positional changes, causing a momentary drop in blood pressure that affects your balance and clarity. Doctors refer to this condition as orthostatic hypotension or postural hypotension. It’s a type of low blood pressure that occurs when you transition from a sitting or lying position to a standing position. This condition affects measurements called orthostatic vital signs, which are used to check how your body reacts when you shift positions.
Most people feel this sensation for a short time without any major problems, but some deal with orthostatic intolerance often. They may notice other symptoms when standing, such as blurry vision, ringing in the ears, weak leg muscles, a pounding heartbeat, or aches around the neck and shoulders. Sometimes, they also feel out of breath, struggle to focus because of reduced blood flow to the brain, or show signs of autonomic issues such as trouble with digestion or erectile difficulties.
If these signs show up when you stand and go away once you sit back down, you could be dealing with orthostatic hypotension. The term “orthostatic” refers to the body’s position when standing upright. This condition occurs because blood pressure drops below normal when you transition from a sitting or lying position to a standing position. The sympathetic nervous system, which manages blood pressure and blood vessel resistance, might not act fast enough to handle the pull of gravity on your blood flow.
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Orthostatic hypotension has a big effect on everyday life. It increases the risk of falling and makes it more difficult to perform tasks that require standing. It also lowers your quality of life and might cause problems like chest pain or arrhythmias. However, treatments exist that effectively control this condition.
Suggestions to ease symptoms and avoid orthostatic hypotension
Taking certain steps can help manage symptoms of orthostatic hypotension. Try following these ideas:
- Pause briefly. Before standing up, wait about 30 seconds before taking a step forward. This brief pause helps lower the risk of falling and can mitigate the effects of orthostatic hypotension.
- Cut back on alcohol. Drinking alcohol can make blood vessels widen, which worsens symptoms of orthostatic hypotension and can lead to lower blood pressure.
- Think about your meal portions. If your blood pressure drops after eating (known as postprandial hypotension), try eating smaller meals with fewer carbohydrates. Drink water with your meals and avoid hot drinks, as they can exacerbate orthostatic symptoms.
- Drink enough water throughout the day. Keep a water bottle with you and ensure you drink plenty of fluids to maintain your blood volume. You can add salt to your meals to help retain fluids, but if you have high blood pressure or orthostatic hypertension, consult your doctor to determine the recommended amount of salt.
- Stay active and move often. Exercising can lessen symptoms of orthostatic hypotension and make it easier to manage orthostatic intolerance. Physical activity can also help prevent your body from becoming less conditioned, which may lead to more issues with orthostatic hypotension.
- Use the right way to bend down. Instead of bending your back to pick things up, squat down using your knees. This can prevent sudden changes in your blood pressure when you stand.
- Shift positions. Start by moving from lying down to sitting up, and then stand. If you feel dizzy when you get up, return to your last comfortable position until the dizziness subsides. start walking once you’re steady and no longer experiencing orthostatic symptoms.
- Raise the head of your bed. Place blocks about 3 to 4 inches high under the head of your bed. This change can help alleviate daytime orthostatic hypotension and improve your ability to manage ongoing symptoms.
- Try wearing compression clothing. Full-length compression stockings may help by preventing blood from pooling in your legs, which can be beneficial for managing neurogenic orthostatic hypotension.
- Do muscle exercises. If you notice signs of orthostatic hypotension, cross your legs like scissors and press them together. This helps push blood from your legs back to your heart. Another option is the Valsalva maneuver. This means blowing out while keeping your airway closed, which may temporarily raise your blood pressure. Check your medications. Talk to your doctors about whether any medicines you’re taking, like those for high blood pressure, could be causing symptoms of orthostatic hypotension. Certain drugs, including beta blockers, diuretics, tricyclic antidepressants, antipsychotics, and alpha blockers, may play a role in this condition. Your doctor may recommend switching medications or adding new ones to help maintain a balance in your orthostatic blood pressure. Always consult a healthcare professional before discontinuing any medication.
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Orthostatic hypotension can manifest in various ways, ranging from mild to severe. To manage it well, people need to understand its causes. Dehydration, specific medications, and issues with the autonomic system are common reasons. Other medical problems like diabetes Parkinson’s, heart failure, kidney failure, or heart-related diseases can also play a role. Low vitamin B12 levels, problems with the adrenal glands, and inadequate fluid levels may also contribute to it.
Initial orthostatic hypotension occurs within the first 15 seconds after standing up and resolves quickly. This occurs because the heart’s output and the body’s need for blood flow fall out of sync. Orthostatic vasovagal syncope is another condition related to this. It can cause feeling dizzy or fainting due to a sudden drop in blood pressure when standing up.
To address frequent lightheadedness or persistent symptoms when standing, consult your healthcare team. They can figure out if it’s classic orthostatic hypotension, delayed orthostatic hypotension, or another type, and they can create a treatment plan designed to match your situation.
Your doctor may suggest monitoring your blood pressure to assess how it changes with posture, including both systolic and diastolic levels. They could also recommend a tilt table test to see how your body reacts when your position changes. This test helps identify conditions such as orthostatic hypotension and others, including vasovagal syncope or postural tachycardia syndrome.
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Doctors may use other tests like a Holter monitor to spot irregular heartbeats or an electrocardiogram (ECG) to check how the heart is working. A stress test can be used to assess how well the cardiovascular system functions under stress. An echocardiogram helps assess the heart’s structure and function. These tests are conducted to identify hidden heart problems that may be associated with orthostatic hypotension.
The baroreceptor reflex, which helps regulate blood pressure, may not function properly in individuals with orthostatic hypotension. Understanding how this works can lead to the creation of better treatments and management options. Some people with this condition also deal with supine hypertension, where blood pressure goes up while lying down, which makes managing orthostatic hypotension trickier.
Orthostatic hypotension is often linked to several neurodegenerative diseases like multiple system atrophy and pure autonomic failure. These illnesses can bring on more serious and ongoing symptoms of orthostatic hypotension. Over time, this condition may also contribute to cognitive decline and increase the risk of falls or injuries.
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People with autonomic dysfunction and orthostatic hypotension could also face bladder issues or act out dreams while asleep. These problems, combined with orthostatic hypotension, can affect how a person lives and often call for thorough treatment plans.
Working with your doctor and using these management tips can help you better manage orthostatic hypotension symptoms and lead a healthier life. This condition can be tough, but paying attention to how you move and taking the right steps can make a big difference for many people.
Source: Mayo Clink (May 26, 2022). Feeling faint? What to do about orthostatic hypotension. https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548
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