Orthostatic hypotension

What is orthostatic hypotension?

  • Decrease of 20mmHg of systolic BP / 10mmHg of diastolic BP within 3mins when standing compared with the BP during sitting or lying
  • Commonly seen in the elderly, individuals with neurologic conditions (eg. Parkinson’s Disease, Diabetic neuropathy)

Ways to prevent orthostatic hypotension: As easy as ABC 😉


A: Abdominal compression


-Wear the abdominal binder when out of the bed


B: Bolus of water

-Drink a glass of water (500ml) rapidly

(It can be used when prolonged standing is expected)


B: Bed up

-Elevate the head of bed 10-20 degrees or 4 inches (about 10cm)

-Maintain upright position during day time


C: Countermaneuvers


  1. i) Slow marching in place

ii) Toe raising

iii) Leg elevation

iv) Contract muscles below the waist isometrically for the 30s


v) Leg crossing and contract

D: Drugs

  • Midodrine
  • Fludrocortisone
  • Pyridostigmine


E: Exercises

  • Mild physical exercises in lying/sitting position
  • Recumbent bike, swimming, light weight lifting

F: Fluid and salt

  • Fluid intake: Take 8 glasses of water every day
  • Salt intake: Take 150-250mmol of sodium (10-20g of salt) per day
  • Keep maintaining with high potassium diet (eg. Bananas, and vegetables with high potassium content)



  1. Figueroa, J. J., Basford, J. R., & Low, P. A. (2010). Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleveland Clinic journal of medicine, 77(5), 298–306. https://doi.org/10.3949/ccjm.77a.09118
  2. Bouvette CM, McPhee BR, Opfer-Gehrking TL, Low PA. Role of physical countermaneuvers in the management of orthostatic hypotension: efficacy and biofeedback augmentation. Mayo Clin Proc. 1996 Sep;71(9):847-53. doi: 10.4065/71.9.847. PMID: 8790259.
  3. Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011 Sep 1;84(5):527-36. PMID: 21888303.

Article by

Yue Jia 


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