Postural Hypotension: When Standing Up Causes Dizziness

Postural hypotension, also known as orthostatic hypotension, is a significant and often under-recognised cause of dizziness and falls in older adults. It occurs when blood pressure drops rapidly upon standing, reducing blood flow to the brain and causing dizziness, light-headedness, blurred vision, and sometimes fainting.

The condition is defined as a drop in systolic blood pressure of 20 mmHg or more, or a drop in diastolic pressure of 10 mmHg or more, within three minutes of standing. It becomes more common with age, affecting approximately twenty per cent of adults over sixty-five and thirty per cent of those over seventy-five.

The causes are varied. Age-related changes in the autonomic nervous system (which regulates blood pressure) mean that the body is slower to adjust blood pressure on standing. Dehydration is a common contributor — older adults often have reduced thirst sensation and may not drink enough. Medications frequently cause or worsen postural hypotension — particularly blood pressure medications, diuretics, antidepressants, and Parkinson's medications. Underlying conditions such as diabetes (which can damage the autonomic nerves), Parkinson's disease, and prolonged bed rest also contribute.

Management involves several approaches. Hydration is essential — aim for six to eight glasses of fluid daily unless medically advised otherwise. Stand up slowly, particularly in the morning or after sitting for long periods. Sit on the edge of the bed for a minute before standing. Avoid prolonged standing, particularly in hot weather. Compression stockings can help prevent blood pooling in the legs. Medication review with your GP may identify medications contributing to the problem, and adjustments may be possible.

For patients with Parkinson's disease, postural hypotension is particularly common and requires careful management alongside other symptoms. Our Parkinson's physiotherapy service addresses this as part of comprehensive management. Our falls prevention programme includes blood pressure assessment and management strategies, while our elderly physiotherapy service provides general support for older adults with dizziness and balance problems.