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Getting out of bed: who thought it would be so dangerous? Orthostatic hypotension!

Updated: Dec 6, 2022

Do you get out of bed quickly?

  • Yes

  • No

What is orthostatic hypotension?

Orthostatic hypotension, commonly called postural hypotension, is the dramatic drop in blood pressure when we stand up quickly [1]. Blood collects in our legs and feet, causing a temporary reduction in blood flow to the heart [1].

While orthostatic hypotension is more severe in the morning as we wake up, orthostatic hypotension occurs every time our body experiences a quick change in posture (sitting to standing) [2].

Approximately 5% of people <50 years old experience orthostatic hypotension, while this jumps to 70% for people >70 years old [3].

Orthostatic is mainly asymptomatic [3].

Causes of orthostatic hypotension?

  • Long-term bed rest [3]

  • Dehydration [1,3]

  • Pregnancy [1,4]

  • Existing cardiovascular diseases (either diagnosed or undiagnosed conditions) [4]

  • Some medications [1]

  • Excessive vomiting or diarrhoea [1,4]

  • Kidney failure [4]

  • Neurodegeneration, such as dementia [5]

  • An impaired connection between the brain and the blood pressure receptors [6]

  • Ageing [7]

  • Autoimmune diseases [1,4]

Symptoms of orthostatic hypotension

  • Lightheaded

  • Dizziness

  • Fainting

  • Falls

  • Chest pain [1-7]

Consequences & dangers of orthostatic hypotension

  • Chest pain

  • Stroke

  • Dizziness and lightheaded

  • Heart failure

  • Heart rhythm problems, such as atrial fibrillation

  • Increased risk of falls (and associated injuries from falls)

  • Quality of life might be affected [1-7]

Prevention & management of orthostatic hypotension

  • Identify the underlying cause of the orthostatic hypotension

  • Individualised treatment (no generalisation)

  • Drink plenty of water before bed

  • Avoid alcohol before bed

  • Elevating your head during normal sleep

  • Compression sock during sleep

  • Exercise

  • Take more time getting out of bed (slowly change your posture) [2]

  • More appropriate and better management of other pathological and heart diseases [1-7]

  • Quit smoking [8]

Who is most at risk?

  • Those who have current cardiovascular diseases, such as hypertension or atrial fibrillation [1-7]

  • Elderly (65 years and older) [2]

  • Smokers [8]

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[1] Benvenuto LJ, Krakoff LR. Morbidity and Mortality of Orthostatic Hypotension: Implications for Management of Cardiovascular Disease. American Journal of Hypertension. 2011;24(2):135-44.

[2] Gorelik O, Fishlev G, Litvinov V, Almoznino‐Sarafian D, Alon I, Shteinshnaider M, et al. First morning standing up may be risky in acutely ill older inpatients. Blood Pressure. 2005;14(3):139-43.

[3] Ricci F, Caterina RD, Fedorowski A. Orthostatic Hypotension. Journal of the American College of Cardiology. 2015;66(7):848-60.

[4] Fedorowski A, Ricci F, Hamrefors V, Sandau KE, Chung TH, Muldowney JAS, et al. Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem. Circulation: Arrhythmia and Electrophysiology. 2022;15(3):e010573.

[5] Young TM. Orthostatic hypotension and dementia: Associated but not guilty. 2022.

[6] Olshansky B, Muldowney J. Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension. The American Journal of Cardiology. 2020;125(10):1582-93.

[7] Low PA. Prevalence of orthostatic hypotension. Clinical Autonomic Research. 2008;18(S1):8-13.

[8] Ko H-L, Min H-K, Lee S-W. Risk of chronic kidney disease associated with orthostatic hypotensive stress: A community-based Korean study. American Journal of Hypertension. 2022.


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