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Orthostatic Hypotension

Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju
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Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju

Orthostatic Hypotension or Postural Hypotension (Coat Hanger Pain) is a form of arterial hypotension in which blood pressure drops sharply when the body position changes from a sitting or lying position to a standing position. The patient experiences dizziness or a feeling of emptiness in the head and may even faint. Sometimes similar conditions occur after trauma to the spinal cord.

When a person stands up abruptly, a large amount of blood enters the vessels of the lower extremities. Its volume can reach one liter. In this case, venous return decreases cardiac output decreases, which causes hypotension. This is a normal physiological process that occurs even in healthy people. The sympathetic nervous system is responsible for normalizing pressure when changing body position. A person’s pulse reflexively increases vascular tone increases. Thanks to this, the pressure immediately returns to normal. When taking an upright position, the pathological signs characteristic of hypotension do not appear or go away almost imperceptibly in healthy people. If a person stays in the supine position for a long time, the production of vasopressin increases due to natural compensation mechanisms. Its effect helps to increase the volume of circulating blood.

This disease is often mild, appears after the transition to an upright position, and persists from several seconds to several minutes. Mild orthostatic hypotension often does not require treatment. Many people occasionally experience vertigo or emptiness after standing up, which is usually not a reason for concern. This disease may indicate more serious problems, so if you often feel dizzy when standing up, you should consult your doctor. If episodes of loss of consciousness appear, even if they last for a few seconds, or if Hanger Pain is present, you should go to the clinic as soon as possible.

Treatment for more severe cases depends on the reason.

Postural Hypotension Signs and Symptoms

Postural hypotension symptoms

When a person stands up abruptly, a large amount of blood enters the vessels of the lower extremities. Its volume can reach one liter. In this case, venous return decreases cardiac output decreases, which causes hypotension. This is a normal physiological process that occurs even in healthy people. 

  • The sympathetic nervous system is responsible for normalizing pressure when changing body position. 
  • A person’s pulse reflexively increases vascular tone increases. Thanks to this, the pressure immediately returns to normal. 
  • When taking an upright position, the pathological signs characteristic of hypotension do not appear or go away almost imperceptibly in healthy people. If a person stays in the supine position for a long time, the production of vasopressin increases due to natural compensation mechanisms. Its effect helps to increase the volume of circulating blood.

The most common symptom of orthostatic hypotension is a feeling of emptiness or vertigo when standing upright from a sitting or lying position. This sensation, like other symptoms, usually occurs immediately after standing up and usually lasts for a few seconds.

Postural hypotension symptoms:

  • Feeling empty or dizzy right after getting up
  • Blurred vision
  • Weakness
  • Loss of consciousness (fainting)
  • Confusion of consciousness
  • Nausea
  • With severe symptoms or trauma to the spinal cord, the patient may fall due to loss of balance. 
  • In some people, seizures are added to this symptomatology. As a rule, the manifestations of pressure fluctuations are more pronounced after a large meal or exercise. 
  • The duration of symptoms depends on the severity of the condition. In some patients, signs of impaired pressure regulation last several minutes; for others, everything goes away in seconds. 
  • The patient has to take a horizontal position in severe cases, as he does not feel well when standing.

Orthostatic Hypotension Causes

Depending on the causes of this condition, the following forms of hypotension are distinguished.

  • Primary. This is a special form of neurosis-like disease of the vasomotor centers of the brain. The main causes of primary hypotension: severe stress, prolonged emotional stress.
  • Secondary. It is often a concomitant pathology in certain thyroid gland diseases, hepatitis, anemia, tumor diseases, gastric ulcer, tuberculosis, rheumatism, cirrhosis of the liver, brain injuries, and taking several medications, etc.

Often, orthostatic hypotension is a sign of vegetative-vascular dystonia of the state of the body, which is characterized by a violation of the activity of the autonomic nervous system, which regulates the work of organs. This can lead to a dysregulation of the cardiovascular system of the nervous and endocrine systems, and, accordingly, to a violation of heart rate, thermoregulation, a decrease in vascular tone, etc. develops due to hormonal disruptions, neuroses, severe stress, and psychological trauma, exposure to harmful occupational factors, alcohol abuse.

Postural hypotension can also develop in healthy people, such as athletes with regular exercise. In this case, low blood pressure acts as a kind of protective reaction of the body. A sudden change in climatic or weather conditions, an increase in humidity, the action of electromagnetic fields, radiation, etc., can also lead to a decrease in pressure. 


Complications of orthostatic hypotension

Complications of Orthostatic Hypotension

Often, rare cases of hypotension, manifested by weakness, lethargy, nausea, and other no more than unpleasant symptoms, are not accompanied by fatal consequences for the body. They only reason discomfort and reduce performance. However, constant or systematic lowering of blood pressure can negatively affect the work of the heart. Therefore, orthostatic hypotension treatment is required.

  • Cardiac manifestations. People with hypotension are at increased risk of serious cardiovascular problems. A fast pulse means that the heart is working intensively. This is a kind of compensatory mechanism to provide tissues with oxygen, which is not enough due to the slow movement of blood through the vessels with low tone. However, a fast pulse is a serious strain on the heart.
  • Hypotension and pregnancy. Postural hypotension during pregnancy is a reason to see your doctor. If the expectant mother has systematic low blood pressure, this can lead to oxygen starvation of the fetus due to poor oxygen supply to the placenta. This, in turn, threatens disruptions in the unborn baby’s development. It was found that pregnant women with low blood pressure more often and more severely experience toxicosis and gestosis. Changes in pressure during pregnancy are often difficult to detect. Fatigue, weakness, nausea, and other signs of hypotension are often confused with the characteristic symptoms of pregnancy provoked by hormonal imbalance.

It is important to say that a sharp and sudden drop in pressure with a deterioration in well-being may indicate intense internal bleeding, heart attack, and other internal problems that threaten a person’s life. In such cases, you should immediately consult a doctor.

When Should You See a Doctor for Coat Hanger Pain?

Occasional dizziness or a feeling of emptiness in the head may be relatively mild and may result from mild dehydration, low blood sugar, prolonged exposure to the sun, or, for example, a hot bath. Dizziness or emptiness in the head may also occur when standing up after sitting for a long time, such as at a lecture, concert, or church service. If these symptoms are episodic, they usually do not represent a cause for concern.

  • If symptoms of orthostatic hypotension are frequent, it is important to consult a doctor. They may indicate a more serious disorder in some cases, especially if Hanger Pain is present. It is useful to keep a special diary to record the time of the onset of symptoms, their duration, and their actions when they appeared. 
  • If symptoms occur frequently enough to be dangerous for you and those around you, you should consult your doctor.

Patients may experience a significant increase in heart rate. This phenomenon is called postural tachycardia. The heart rate increases to 120 or more beats per minute. If in a person, when changing the body’s position, the pulse accelerates by more than 30 beats, then this is also postural tachycardia. In some patients, an increase in heart rate is accompanied by dizziness and weakness, but the pressure is reduced slightly or remains normal. Experts have not yet figured out what caused this condition.

Orthostatic hypotension diagnosis

Orthostatic Hypotension Diagnosis     

To diagnose hypotension, a general practitioner performs several steps:

  • carefully collects complaints, analyzes the description of each of the symptoms of hypotension;
  • finds out if there is a hereditary predisposition, negative factors, etc.
  • examines the patient and listens to the heart and lungs;
  • performs a thorough three-time pressure measurement, and, if necessary, sets pressure monitoring for a week or more, daily pressure monitoring;
  • gives a referral to a cardiologist, neurologist or endocrinologist;
  • analyzes the conclusion on the composition of blood and urine, which includes a general and biochemical analysis, a blood test for glucose levels, protein spectrum, ionic composition;
  • determines the level of catecholamines in the urine and blood, the endocrine profile;
  • directs to ultrasound of the heart, electrocardiography;
  • conducts stress tests.

In some cases, additional CT or MRI of the head, ultrasound of the kidneys, adrenal glands, and thyroid gland are performed before treatment.

Treatment of the Orthostatic Hypotension

To eliminate the pressure drop when changing the body’s position, you need to act on the disease that led to a similar condition. Treatment of pathology is divided into medication and non-medication. The patient will have to reconsider their habits.

  • First of all, it is necessary to normalize the drinking regimen, provide moderate physical activity, and give up alcohol.
  • Physical activity improves vascular health and has a positive effect on blood circulation.
  • If the patient had to constantly adhere to bed rest, it is undesirable to spend all the time lying down. It is necessary to get up periodically or just sit down.
  • For older patients, it is recommended to sleep with a raised headboard. It is important to provide the body with the right amount of sodium, increasing fluid volume inside the vessels. To do this, you need to take sodium supplements or increase the amount of salt in the diet. This option has contraindications if the patient has heart or kidney problems. Excess sodium in the diet leads to edema.
  • People who have orthostatic hypotension caused by excessive carbohydrate or heavy food intake should reconsider their diet. It is essential to reduce the number of foods high in carbohydrates and food in general. After eating, you need to get up smoothly, avoid sudden movements.
  • It is also recommended to wear elastic stockings, due to which venous return is increased.

If non-drug treatment has failed, the doctor will prescribe medication. Drug therapy is possible only as directed by a doctor since drugs have contraindications and can cause side reactions.


  • What is orthostatic hypotension?

Orthostatic hypotension manifests itself when the position of the body changes, which causes a sharp drop in blood pressure. The frequent manifestation of such conditions is not the norm.

  • How to detect orthostatic hypotension?

In order to determine the presence of orthostatic hypotension, you need to measure the pressure. A strong decrease in blood pressure when standing up is an indication of abnormal body behavior.

  • Who Treats Orthostatic Hypotension?

This type of disorder in the human body is treated by a therapist and a cardiologist. If your blood pressure fluctuates frequently, see your doctor.

  • What is the pressure with arterial hypotension?

Hypotension is low blood pressure in a person. Some people may have low blood pressure from birth.

  • Which disease can cause weakness, pale skin, and dizziness?

These are symptoms of orthostatic hypotension, but in order to find out for sure, consult a doctor. Only a qualified doctor can make the correct diagnosis and prescribe treatment.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
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16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
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16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
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I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
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21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
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Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
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00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
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15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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  1. 25/11/2023

    Very informative ,I need to know more about a cure or a way to live with my condition,

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