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Published on June 01, 2021

What’s with this dizziness when I stand up?


Ever get dizzy, even pass out, after standing up? That’s what doctors call postural hypotension, which means your blood pressure plummets when you go from lying down or sitting to standing.

It’s a common affliction that can strike anyone, often caused by dehydration, but can be brought on by health conditions and medications. Symptoms can include blurred eyesight, palpitations, weakness, nausea, trouble breathing, headache, and chest, neck or shoulder pain, according to the American Academy of Family Physicians.

“We probably see it daily, particularly in our older population,” said Michael J. Rest, MD, of Falmouth Hospital Emergency Physicians. “We get an uptick in the summer with younger college students who get dehydrated or are drinking on the beach.”

“We often see this Sunday mornings,” he added. “People standing up and down, maybe haven’t had something to eat.”

For younger people, postural hypotension, also known as orthostatic hypotension, may be a one-time thing. Dr. Rest said causes include dehydration from:

  • Exercise
  • Drinking alcohol
  • Vomiting

In addition, pregnant women in their third trimester may be subject to wooziness when they stand up because much of their blood supply pools in their legs, he said.

For older people, postural hypotension may be a recurring or chronic problem caused by health conditions, such as:

  • Aortic stenosis (narrowing of the main vessel exiting the heart, which Dr. Rest said keeps the heart from pumping out blood fast enough to respond to a rapid change in posture).
  • Diabetes, when it damages nerves in your autonomic system, which controls bodily functions.
  • Addison’s disease (when your adrenal glands don’t produce enough hormones, especially cortisol, according to the National Institute of Diabetes and Digestive and Kidney Diseases).
  • Some neurological disorders.
  • A lengthy period of bed rest, according to the National Institute of Neurological Disorders and Strokes.

Medications that increase the risk of postural hypotension include:

  • Blood pressure drugs
  • Diuretics
  • Vasodilators
  • Flomax (tamsulosin hydrochloride), used to help men with enlarged prostates urinate. It relaxes the smooth muscle of the bladder and urethra, but also muscle cells lining blood vessels, Dr. Rest said.
  • Some psychiatric drugs, including clonidine, used to treat anxiety, he said. According to the National Library of Medicine, this drug lowers blood pressure and heart rate.

“A lot of primary doctors struggle with this, because the patient needs a medication, but it has side effects,” he said.

When prescribing a drug known to possibly cause postural hypotension, physicians usually talk to their patients about the risk and how to avoid fainting and falls by standing up slowly while holding onto something solid for support, Dr. Rest said.

Postural hypotension strikes older people more often because they’re “more likely to be on multiple medications and more likely to get dehydrated,” he said. They’re also more prone to have one or more conditions that raise their risk. Even their age alone makes them more susceptible.

“The older body doesn’t respond to changes as quickly,” he added.

Should you end up at Falmouth Hospital’s Emergency Department because you fainted or nearly fainted, he said the staff may run a series of tests, potentially including:

  • EKG (electrocardiogram), to look for any heart arrhythmia.
  • A standard blood panel, to check for anemia.
  • Blood test for electrolytes, to assess levels of potassium and sodium (these substances affect blood pressure), and kidney function.
  • Temperature and white blood cell count, to detect any fever or infection.

Treatment typically includes an IV infusion of fluid. If tests indicate the problem resulted from an underlying condition or a medication, then treatment would be tailored to limit the cause. Patients’ primary care providers are also notified.