Manage orthostatic hypotension by staying hydrated with water or electrolyte drinks (≥240 mL, peak effect at 30 minutes), wearing compression stockings (20–30 mmHg), and practicing fall prevention techniques like lying down or crossing your legs if feeling faint. For persistent symptoms, pharmacologic options like midodrine or fludrocortisone may help. Consult your doctor about safely increasing fluids and sodium intake if appropriate.
January 13, 2025

Orthostatic Hypotension: American Heart Association Guidelines

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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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

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