Orthostatic hypotension is defined as a drop in systolic blood pressure ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing. It results from inadequate autonomic regulation of blood pressure, though inadequate hydration and medications often are contributory.
According to the 2017 American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines:
First-line recommendations:
Fluid management: When you feel faint, drink water or an electrolyte-balance fluid like Gatorade. The peak effect occurs 30 minutes after ingestion of ≥240 mL and additional benefit seen with ≥480 mL.
Fall prevention: For those with a shorter warning “prodrome” of feeling faint, lie down immediately to avoid falling. Longer prodrome: drink water quickly, try squatting down or crossing your legs and squeezing, tighten your stomach or march in place.
Compression stockings: 20-30 mmHg compressive pressure at least up to thighs to improve venous return. Should be worn long-term all day, every day. Elasticity is lost over time; use two pairs that should be alternated daily and replace after 6–9 months. Truform 20-30 Mmhg Compression Stockings.
Pharmacologic therapy:
Midodrine: Start with 2.5 mg orally two to three times daily, titrate to 10 mg as needed.
Fludrocortisone: 0.1-0.2 mg daily to expand plasma volume.
Mitigation managements: Avoid medications that exacerbate orthostatic hypotension (e.g., diuretics, certain antihypertensives). Discuss alternatives with a healthcare provider.
Ask your doctor:
Increased fluids and salt: Increase baseline fluid (2–3 liters/day) and sodium intake (6-9g per day) may be beneficial if not contraindicated (you have heart failure, kidney failure, liver failure, uncontrolled hypertension, or other condition).
Citation
Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. J Am Coll Cardiol. 2017; 70(5): p.e39-e110. doi: 10.1016/j.jacc.2017.03.003
