Treatment

The goal of treatment for orthostatic hypotension is to restore normal blood pressure. That usually involves increasing blood volume, reducing the pooling of blood in your lower legs and helping blood vessels to push blood throughout your body.

Treatment often addresses the underlying cause — dehydration or heart failure, for example — rather than the low blood pressure itself.

For mild orthostatic hypotension, one of the simplest treatments is to sit or lie down immediately after feeling lightheaded upon standing. Your symptoms should disappear.

When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication or stopping it entirely.

Orthostatic hypotension treatments include:

  • Lifestyle changes. Your doctor may suggest several lifestyle changes, including drinking enough water; drinking little to no alcohol; avoiding overheating; elevating the head of your bed; avoiding crossing your legs when sitting; and standing up slowly.

    If you don't also have high blood pressure, your doctor might suggest increasing the amount of salt in your diet. If your blood pressure drops after eating, your doctor may recommend small, low-carbohydrate meals.

  • Compression stockings. Compression stockings and garments or abdominal binders may help reduce the pooling of blood in your legs and reduce the symptoms of orthostatic hypotension.
  • Medications. Several medications, either used alone or together, can be used to treat orthostatic hypotension. For example, the drug fludrocortisone is often used to help increase the amount of fluid in your blood, which raises blood pressure. Midodrine raises standing blood pressure levels by limiting expansion of your blood vessels, which in turn raises blood pressure.

    Droxidopa (Northera) may be prescribed to treat orthostatic hypotension associated with Parkinson's disease, multiple system atrophy or pure autonomic failure.

    Other medications, such as pyridostigmine (Regonol, Mestinon), nonsteroidal anti-inflammatory drugs (NSAIDs), caffeine and epoetin (Epogen, Procrit, others), are sometimes used, too, either alone or with other medications for people who aren't helped with lifestyle changes or other medications.

July 11, 2017
References
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  2. What is hypotension? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hyp/. Accessed March 23, 2017.
  3. Kaufmann H, et al. Mechanisms, causes, and evaluation of orthostatic hypotension. http://www.uptodate.com/home. Accessed March 23, 2017.
  4. Low blood pressure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Low-Blood-Pressure_UCM_301785_Article.jsp. Accessed March 23, 2017.
  5. Shen WK, et al. 2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope. Heart Rhythm. In press. Accessed March 23, 2017.
  6. What is an electrocardiogram? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/ekg/. Accessed March 23, 2017.
  7. What is echocardiography? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/echo/. Accessed March 23, 2017.
  8. Kaufmann H, et al. Treatment of orthostatic and postprandial hypotension. http://www.uptodate.com/home. Accessed March 23, 2017.
  9. Gibbons CH, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypotension. Journal of Neurology. 2017 Jan 3.
  10. Drug approval package: Northera (droxidopa) capsules approval letter. U.S. Food and Drug Administration. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/203202Orig1s000TOC.cfm. Accessed March 21, 2017.
  11. AskMayoExpert. Orthostatic hypotension initial evaluation. Rochester, Minn.: Mayo Foundation for Medical Education and Research; August 2016.
  12. AskMayoExpert. Orthostatic hypotension initial treatment. Rochester, Minn.: Mayo Foundation for Medical Education and Research; August 2016.
  13. Low PA (expert opinion). Mayo Clinic, Rochester, Minn. April 3, 2017.