Treatment Overview
For many people, the simple act of standing up can become a source of anxiety. Orthostatic hypotension, a sudden drop in blood pressure upon standing, turns routine movements into moments of dizziness, blurred vision, or even fainting. This condition can severely limit independence, making people afraid to leave their homes or perform basic tasks like getting out of bed. It is not just about feeling lightheaded; the risk of falls and injury is a serious concern that affects daily confidence and safety.
Treatment is essential to stabilize blood pressure and prevent these dangerous drops. The goal is to ensure enough blood reaches the brain when upright, allowing patients to remain active without fear of passing out. Because orthostatic hypotension can stem from various issues, ranging from dehydration and medication side effects to nervous system disorders, treatment plans are highly specific. Doctors assess the underlying cause and the severity of symptoms before prescribing medication (Mayo Clinic, 2022).
Overview of treatment options for Orthostatic Hypotension
The primary objective of treatment is to raise standing blood pressure to a functional level, minimizing symptoms like dizziness. Complete normalization of blood pressure is often not necessary; the focus is on symptom relief and safety.
Typically, doctors begin with non-drug approaches, such as increasing salt and fluid intake or wearing compression stockings. Medications are usually introduced when these lifestyle changes fail to provide sufficient relief or when the condition is severe enough to cause frequent fainting. Pharmacological treatment focuses on two main mechanisms: increasing the volume of blood in the body or tightening the blood vessels to fight gravity.
Medications used for Orthostatic Hypotension
When lifestyle measures are insufficient, doctors often prescribe fludrocortisone as a first-line treatment. This medication helps the body retain more fluid, which increases the total volume of blood in the circulatory system. It is widely used because it addresses the core issue of low blood volume that exacerbates symptoms.
If volume expansion is not enough, or if the cause is related to nerve failure (neurogenic orthostatic hypotension), doctors may prescribe vasoconstrictors. Midodrine is a common choice in this category. It works quickly and is often taken during the day when the patient is active. Another option is droxidopa, which is specifically approved for neurogenic orthostatic hypotension caused by conditions like Parkinson’s disease.
For some patients, pyridostigmine is used as an alternative or add-on therapy. While primarily used for muscle disorders, clinical experience suggests it can improve standing blood pressure without raising blood pressure as much when lying down. Patients taking drugs like midodrine typically feel effects within an hour, while fludrocortisone may take a few days to reach full effectiveness (National Institute of Neurological Disorders and Stroke, 2023).
How these medications work
Fludrocortisone is a mineralocorticoid that acts on the kidneys. It signals the body to hold onto sodium (salt). Since water follows salt, this causes the body to retain fluid, expanding the blood volume. With more blood circulating, pressure is less likely to plummet when standing.
Midodrine and droxidopa work by constricting (tightening) the blood vessels. Midodrine stimulates specific receptors on the small arteries and veins, causing them to narrow. This tightening increases resistance, preventing blood from pooling in the legs and abdomen. Droxidopa works similarly by converting into norepinephrine, a chemical that naturally signals blood vessels to tighten. This ensures blood is pushed upward to the brain rather than settling in the lower body (Cleveland Clinic, 2021).
Side effects and safety considerations
Treating orthostatic hypotension is complicated by “supine hypertension,” where blood pressure rises dangerously when lying down, especially during sleep. Management includes elevating the head of the bed and avoiding late-day doses of standing blood pressure-raising drugs.
Fludrocortisone can cause fluid retention (e.g., swollen ankles) and low potassium, requiring monitoring. Midodrine often causes scalp tingling and may cause urinary retention in men. Both drugs need careful evaluation in patients with heart failure or kidney disease. Severe headache, chest pain, or vision changes warrant immediate medical attention, potentially indicating a hypertensive crisis.
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- Cleveland Clinic. https://my.clevelandclinic.org
- Mayo Clinic. https://www.mayoclinic.org
- National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov
- MedlinePlus. https://medlineplus.gov
Medications for Orthostatic Hypotension
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Orthostatic Hypotension.