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Postural Hypotension -- Why You Black Out When You Stand Up

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November 12, 2015

By SUSAN CALLAHAN, Associate Editor and Featured Columnist




If you black out when you stand up, you may have a condition known as “postural hypotension.” Postural hypotension, also known as “orthostatic hypotension”, can be caused by several other underlying problems, and for this reason, it is one of the most common problems Americans face.


Estimates are that 5 to 6% of all middle-aged Americans suffers from postural hypotension, according to a 2013 study from Vanderbilt University School of Medicine.  Since the 2010 census shows that there are 81.4 million Americans over age 45, that would mean that  approximately 4 million of us have postural hypotension. What are the health dangers of having postural hypotension? Are there any natural remedies for this condition?

What Are the Symptoms of Postural Hypotension?

In mild cases of postural hypotension, you may feel light-headed when you stand. In severe cases, you may lose consciousness and fall.

What Exactly Is Postural Hypotension?









Standing up is a seemingly simple movement that most of us do without much thought dozens of times a day.  

But standing up is actually a complex action.  When you stand up, your nervous system activates a cascade of events. The first thing that is that your  autonomic neural system --- the system that works involuntarily without your having to think about or “will” it to happen --- triggers a process called “baroreceptor unloading”.

Baroreceptors are tiny sensors in each of your blood vessels which continually detect your blood pressure and feedback the information to your brain so that necessary adjustments to your blood pressure can be made.

Next, your blood vessels experience vasoconstriction” which is what it sounds like, a constriction or squeezing action. This squeezing action forces the blood up, working all the time against gravity, to push blood up from your lower legs back towards your heart.

If anything prevents your blood vessels from squeezing down hard enough to push the blood up from your lower legs, then not enough blood reaches your heart and your brain, and you feel light-headed or you pass out. This is postural hypotension.

How Much Must Blood Pressure Drop to Be  a Problem?

Most studies say that postural hypotension or orthostatic hypotension occurs when your systolic blood pressure (the top number of your blood pressure reading) drops by 20 points or more within 3 minutes of standing up. Or, the condition can occur if your diastolic blood pressure (the bottom number) falls by 10 points of more.

Diabetes Is a Leading Cause of  Postural Hypotension

For every diabetic who has had diabetes longer than 10 years,  as many as 20% suffers from postural hypotension, according to a 2001 study from the Peripheral Vascular Disease Clinic, Albert Einstein College of Medicine, Jacobi Medical Center.

Diabetes can affect the ability of your legs to sense that your blood pressure has changed once you stand up. Peripheral neuropathy is the leading reason for the failure of the legs to sense these changes in your posture.   

In addition to peripheral neuropathy, this study also found that 100% of 2000 patients tested over an 18-year period had a condition called “Moenckeberg’s Atherosclerosis”.  

With Moenckeberg’s Atherosclerosis, the arteries have calcium buildup which partially obstructs the vessel, and as a result the arteries cannot efficiently comply with the demands your body places on them.

Postural Hypotension Increases with Age

Among the general population, postural hypotension affects 5% of us. But among the elderly living in institutional settings such as  geriatric wards, the prevalence is 68%, according to a 2002 study from Sackler School of Medicine of Tel-Aviv University. These elderly experience postural hypotension at least once per day. About 35% experience postural hypotension more than twice per day.

Postural Hypotension Can Be Caused By Certain Medications

Studies, including a 2010 study led by  Dr. Juan Figueroa of the Mayo Clinic,  have identified the following as drugs which may trigger postural hypotension:

- α-blockers (alpha-adrenoceptor blockers )


- tricyclic antidepressants

-high blood pressure medications

-calcium channel blockers



Certain Uncommon Disorders Can Cause Postural Hypotension

Certain other rarer disorders can cause postural hypotension. One is amyloidosis, a condition which occurs when amyloid proteins build up in your organs such as your heart or lungs. Interestingly, amyloid proteins have also been implicated in the development of Alzheimer’s disease.  

Parkinson’s disease patients also often suffer from postural hypotension.

Postural Hypotension Raises the Risk of Dying for Certain People

If you have postural hypotension, and you have systolic hypertension (top number over 140), then you have a higher risk of dying than those who do not have these conditions. If your systolic blood pressure drops more than 30 points when you stand up, you have a 60% higher risk of dying than health people of the same age.  

Moreover, if your diastolic blood pressure drops more than 15 points, you have a 40% higher risk of dying. These were the findings from a 2010 study conducted by researchers at Malmö University Hospital  in Sweden.

Among elderly men, having postural hypotension increases the risk of death by 64%, according to   a 1998 study conducted by the Honolulu Heart Program, Kuakini Medical Center in Hawaii.

This study examined data from 3,522 Japanese American men, aged 71 to 93 years old. Over the 4-year period of the study, 473 people died and 52 of them had postural hypotension. After discounting for other factors that could have contributed to the deaths, the scientists estimated that simply having postural hypotension increases your risk of death by 64% compared to someone who does not have the condition.

So What Can You Do?

Remedies for postural hypotension have to be discussed with your doctor. The treatment will depend on the cause of the condition. However, the following are the remedies which scientific studies have found most useful:

1. Perform Specific Exercises

Studies, including a 1994 study from Academic Medical Centre, Amsterdam, have found that the following exercises can combat postural hypotension:

-isometrically contracting the muscles below the waist for about 30 seconds at a time

-Toe-raising. Flexing your toes makes your calves contract which pushes blood upwards. Standing on your toes also contracts your calves

-Leg-crossing and contraction

-Thigh muscle co-contraction

-Bending at the waist

-Slowly  marching in place

-Elevating your legs. When you sit, try to elevate  your legs whenever possible, perhaps using a footrest, an ottomon or even another chair.

2. Wear Compression Stockings and Abdominal Binders  

Generally, remedies include wearing compression stockings to help your arteries to push the blood upwards. Another remedy involves vasoconstriction medicines but these run the risk of giving you high blood pressure when you are lying down (supine hypertension).

In many cases, the compression is actually applied to the abdomen using compression bands called abdominal binders.

3. Drink 2 Glasses of Water

Drinking two  8-ounce glasses of water, if you do it rapidly,  expands your blood volume and increases your systolic blood pressure by between and 37 points in 30 to 35 minutes, according to a 2000 study from Franz Volhard Clinic in Berlin, Germany.

4. Sleep with Your Head Elevated

If you have postural hypotension, you should elevate the head of your bed about 4 inches (10 centimeters) to decrease the occurrence of night time high blood pressure (nocturnal hypertension), according to the 2010 study from the Mayo Clinic.




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