OH — the plain-language one-pager.

What is Orthostatic Hypotension?Diagnosis

Orthostatic Hypotension (OH) is a drop in blood pressure when you stand up — defined as a fall of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing. It causes lightheadedness, dizziness, blurred vision, weakness, and falls — especially in older adults. OH is one of the most common, underdiagnosed, and treatable causes of falls and syncope. The treatment is mostly medication adjustments + behavior, with specific drugs for resistant cases.

• Top causes — Volume depletion (dehydration, diuretics), antihypertensives + alpha-blockers (terazosin/tamsulosin), antidepressants (TCAs, trazodone), antipsychotics, parkinsonian meds (levodopa), opioids, prolonged bed rest, age-related autonomic decline, autonomic failure (diabetes, Parkinson's, multiple system atrophy), adrenal insufficiency.
• Diagnosis — Orthostatic vital signs: BP and HR lying flat, then standing at 1 and 3 minutes. Also tilt-table test for unclear cases. Many older adults have OH without realizing it.
• The "morning surge" pattern — OH is often worst on rising in the morning; many falls happen on the trip from bed to bathroom in the first hour after waking.
• Treatment hierarchy — Step 1: medication review and de-prescribing (this fixes most cases); Step 2: hydration (2-3 L/day) + salt liberalization (4-10 g/day if BP allows) + compression stockings (waist-high, 30-40 mmHg) + slow position changes; Step 3: medications (midodrine, droxidopa, fludrocortisone, pyridostigmine).

Stand up slow — the anti-OH morning routineKnow your plan

The first hour after waking is the highest-risk window for OH-related falls. A 30-second routine prevents most of them.

• Drink 12-16 oz water before getting out of bed — water expands blood volume rapidly.
• Sit at the edge of the bed for 30-60 seconds before standing.
• Stand by a stable surface — bed rail, dresser — for another 30 seconds before walking.
• Compression stockings on before getting out of bed — waist-high if standing alone; knee-high if for milder OH.
• Pre-meal water for postprandial hypotension; avoid large carb-heavy meals.
• If you feel a drop coming: sit or lie down before you fall. Cross legs and clench fists ("counter-pressure maneuvers") buy time.

Your daily Force FieldLive It

• Annual medication review — list every BP med, antidepressant, alpha-blocker, opioid, antipsychotic. Ask your team about de-prescribing or timing changes.
• Hydration 2-3 L/day — water, not alcohol; bolus 12-16 oz on rising and before meals if postprandial.
• Salt liberalization 4-10 g/day if BP allows — discuss with team if you have heart failure or HTN.
• Waist-high compression stockings 30-40 mmHg — daytime, especially mornings.
• Slow position changes — count to 30 sitting up, count to 30 standing before walking.
• Avoid known triggers — large carb meals, alcohol, hot baths/saunas (vasodilation), prolonged standing still.
• Sleep with head of bed elevated 4-6 inches — paradoxically improves morning OH in autonomic failure.
• Counter-pressure maneuvers — leg crossing, fist clenching, calf raises buy time when symptoms come on.
• Track symptoms in your Health Passport — when, what triggered it, what helped. Bring to every visit.

Red flags — call nowAction

• Call your clinic the same day for: new chest discomfort with exertion that goes away with rest (stable lightheadedness on standing worth evaluating); a missed dose of antiplatelet or statin; medication side effects (muscle aches, bleeding, GI symptoms).
• Bring up at next visit: any change in exercise tolerance, lipid follow-up timing, BP log review, smoking-cessation support, depression screening, sleep concerns.