Orthostatic hypotension: Etiology, Pathogenesis, Clinical Symptoms, Diagnostics and Treatment

Viktorija Bleizgytė1

1Lithuanian University of Health Sciences, Faculty of Medicine,



Background. Orthostatic hypotension is a decrease in systolic ABP ≥20 mmHg or a decrease in diastolic ABP ≥10 mmHg after standing up after first 3 minutes. This pathology is not common, but the incidence increases exponentially with age. The absence or poor expression of symptoms increases the risk of fall, as well as morbidity and mortality. The most common risk factors are age, high consumption of drugs, hypertension, diabetes, amyloidosis. OH may include weakness, tiredness, nausea, palpitations, headaches, dizziness, blurred vision, fainting. In a patient, who stood up from a supine position and had a  decreased ABP within the first 3 minutes, established with orthostatic hypotension.

Aim: to review and analyze the sources of scientific literature related to orthostatic hypotension, the causes of its development, main diagnostic methods and principles of treatment.

Methods: scientific literature sources were searched in PubMed, UpToDate, Cohrane Library, ScienceDirect databases. During the literature review, articles related to orthostatic hypotension, its causes of development, diagnostic possibilities, and treatment principles were selected.

Results. If it is not possible to measure the decreased ABP, but if OH is suspected, the ABP can be measured at 24 hours. The goal of OH treatment is to improve symptoms. Non-drug treatment is preferred. The fludrocortisone, midodrine, pyridostigmine can be used. It is recommended for the patient to wear compression clothing, increase physical activity, perform various exercises, consume more salt, drink about 1,5 – 2,5 liters of water. If OH symptoms occur, it is recommended to drink 500 ml of water as quick as possible and sleep with head raised 20 to 30 cm to increase orthostatic tolerance.

Conclusion: this brief review of the scientific literature presents the main aspects of orthostatic hypotension, its etiology and pathogenesis, principles of diagnosis and treatment.


Keywords: Orthostatic hypotension, decrease in arterial blood pressure, compensatory mechanism, venous stasis.