Overview
Diagnosis
Diagnosing orthostatic hypotension involves identifying the underlying cause and determining the best treatment approach. In many cases, the exact cause may not be immediately clear.
Your healthcare provider will typically review your medical history, medications, and symptoms, followed by a physical examination. Several diagnostic tests may also be recommended, including:
• Blood pressure monitoring: Blood pressure is measured while sitting and then again while standing. A drop of 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure within 2 to 5 minutes of standing indicates orthostatic hypotension.
• Blood tests: These help detect conditions such as low blood sugar (hypoglycemia) or low red blood cell count (anemia), both of which can contribute to low blood pressure.
• Electrocardiogram (ECG or EKG): This painless test measures the electrical activity of the heart to identify rhythm changes, heart structure issues, or reduced oxygen supply. In some cases, you may need to wear a portable Holter monitor for 24 hours or longer to record heart activity throughout daily activities.
• Echocardiogram: This imaging test uses sound waves to create moving pictures of the heart and evaluate blood flow, valve function, and structural abnormalities.
• Stress test: Conducted during exercise, such as walking on a treadmill, to assess how the heart performs under physical stress. For individuals unable to exercise, medication may be used to stimulate heart activity.
• Tilt table test: This test measures how your body reacts to changes in position. You lie on a table that tilts upward to simulate standing while your blood pressure is closely monitored.
• Valsalva maneuver: A test that checks how well your autonomic nervous system functions. You breathe deeply and blow against resistance as if inflating a balloon while heart rate and blood pressure are measured.
Treatment
Treatment for orthostatic hypotension focuses on addressing the underlying cause rather than just the drop in blood pressure. If dehydration is the cause, your healthcare provider may recommend increasing fluid intake. If medication is contributing to low blood pressure, adjustments such as lowering the dose or switching drugs may be suggested.
For mild cases, sitting or lying down immediately after feeling dizzy or lightheaded can quickly relieve symptoms. However, if symptoms persist or worsen, medication may be necessary.
Medications that may help include:
• Midodrine (Orvaten)
• Droxidopa (Northera)
• Fludrocortisone
• Pyridostigmine (Mestinon, Regonol)
Your healthcare provider will discuss the potential benefits and risks of each medication to determine the most suitable option for your condition.
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