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Date issued: September 2023

Review date: September 2025 

Ref: C-544/HB/Ward/Postural Hypotension

PDF: Postural Hypotension final September 2023.pdf[pdf] 186KB

What is Postural Hypotension?

It is a fall in blood pressure that occurs when changing position from lying to sitting or from sitting to standing.

What are the Symptoms of Postural Hypotension?

A fall in blood pressure leads to a reduced blood supply to organs and muscles; this can cause a variety of symptoms:

• Feeling dizzy and lightheaded.

• Changes in vision such as blurring, greying or blacking vision.

• Feeling vague or muddled.

• Losing consciousness with or without warning, this is a ‘blackout’ or ‘faint’.

• Pain across the back of the shoulders and neck, ‘coat hanger’ pain.

• Pain in the lower back and buttocks.

• Angina-type pain in the chest.

• Weakness.

• Fatigue.

These symptoms can vary from person to person.

What to do when you get symptoms

Think of the symptoms as a warning that your blood pressure is too low. The only way to improve your blood pressure is to:

STOP what you are doing.

SIT down, use bus stops, walls, benches. Bend forward and press your stomach.

LIE down if possible.

DRINK some water. 

GET UP cautiously when you feel well again.                                                                    

If you faint (blackout) your family or those around you need to:

• Lay you down flat.

• Ensure you are safe, remove any dangers (e.g., hot drinks) and check for breathing and circulation.

• Raise you legs in the air, if possible, for 3 – 5 minutes.

There should be a prompt response to these measures and if not, URGENT medical attention is required, call 999.

When are symptoms likely to happen?

At any time when there is an increased demand on the circulating blood, for example:

• Moving, lying, or sitting/ standing suddenly.

• In the morning, when blood pressure is naturally lower or after bowel motion.

• After meals, as blood is needed by the digestive system. In particular big meals or sugary foods increase this demand. Alcohol also has this affect.

• Straining on the toilet when you are constipated or have difficulty passing urine.

• After not moving for some time, especially bed rest.

The following things will make symptoms worse:

• Being dehydrated.

• Getting overheated; in a warm room, after a hot bath, or on a sunny day.

• Illnesses such as colds or infections, especially if it changes your breathing pattern.

• Anxiety can cause over-breathing which lowers the blood pressure.

• Medication, some medication can worsen Postural Hypotension.

Tips for improving control of your Postural Hypotension

New tablets

• Ask if your blood pressure will be affected by any new tablets or over the counter medicines.

• Read the information leaflets that come with your tablets.

Circulation exercises: these simple exercises stimulate your circulation. You can do them in bed or whilst sitting and should do them before you change position or if you have been sitting or lying down for a while.

• Pump your feet up and down at your ankles.

• Crossing and uncrossing your legs.

• Do gentle ‘marching’ on the spot, raising alternate legs.

Move safely

• Take your time when changing your position, sit for a while before you stand up and stand until you feel steady before you walk. Do not rush to answer the phone or doorbell or going to the toilet.

• Try not to sit or stand for long periods. If you are doing a task when standing, try lifting alternate heels, or rocking from your toes to your heels alternately.

• Sit down to do tasks like getting dressed, ironing.

• When bending or reaching, do so slowly holding onto a firm support. Avoid sudden turning movements and over-reaching.

Take it easy in the morning

• Prepare morning medication and a drink the night before and leave it by your bed.

• Take blood pressure medication before you get out of bed.

• Get out of bed in stages. Do some circulation exercises  before sitting up slowly and again before standing.

• Sit down again if you have symptoms at any time.

Keep your head up in bed

• Sleeping with your head up at night helps to boost your blood  pressure when you get out of bed, use two pillows.

Avoid dehydration

• Increase your fluid intake. Drink 3 - 4 pints (1.5 - 2 litres) of fluid every day or as your doctor allows.

• Drink a glass of water before you get out of bed in the morning if able.

Support Stockings: These are to stimulate circulation and are prescribed by a doctor if required.

Mealtimes

• Large meals may cause a drop in blood pressure 1 or 2 hours later.  

• Avoid excessive alcohol, this will make your symptoms worse.

• Avoid large amount sugary foods and drinks.

Exercise

• Keep active and exercise regularly.

• Try and pace yourself. Have frequent rests to avoid  exhaustion. 

Preventing constipation

• Eat foods with fibre (e.g., cereals and fruit) every day.  Have a healthy balanced diet.

• Keep well hydrated.

• Avoid straining for the toilet and if constipated see a doctor.

Keeping cool

• Avoid overheated environments. Use a fan to cool you down.

• Do not sit in the sun for long periods.

• Keep hydrated with extra fluids.

• Avoid long periods of time in a hot bath or shower.

See your GP

• If your postural hypotension symptoms are getting worse or you are concerned.

• Have regular reviews of your lying and standing blood pressure.