Treatment

The goal of treatment for orthostatic hypotension is to restore normal blood pressure. That usually involves increasing blood volume, reducing the pooling of blood in your lower legs and helping blood vessels to push blood throughout your body.

Treatment often addresses the cause — dehydration or heart failure, for example — rather than the low blood pressure itself.

For mild orthostatic hypotension, one of the simplest treatments is to sit or lie back down immediately after feeling lightheaded upon standing. Your symptoms should disappear.

When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication or stopping it.

Orthostatic hypotension treatments include:

• Lifestyle changes. Your doctor may suggest several lifestyle changes, including drinking enough water; drinking little to no alcohol; avoiding overheating; elevating the head of your bed; avoiding crossing your legs when sitting; and standing up slowly. Then pause briefly to be sure it's ok for you to start walking.

If you don't also have high blood pressure, your doctor might suggest increasing the amount of salt in your diet. If your blood pressure drops after eating, your doctor may recommend small, low-carbohydrate meals.

• Compression stockings. Compression stockings and garments or abdominal binders may help reduce the pooling of blood in your legs and reduce the symptoms of orthostatic hypotension.

• Medications. A few drugs are used to treat orthostatic hypotension, including midodrine (Orvaten) and droxidopa (Northera). Side effects of midodrine can include retaining urine, tingling or itchy scalp, and goose-bumps. Side effects of droxidopa can include nausea, headache and bladder pain. With either drug, avoid lying flat for four hours after taking it to reduce the risk of high blood pressure while lying down.

  Fludrocortisone is often used to help increase the amount of fluid in your blood, which raises blood pressure, but it can have serious side effects. If you take fludrocortisone, your doctor will monitor you for side effects.

  Another medication is pyridostigmine (Mestinon, Regonol). This drug might be more effective combined with midodrine. Side effects can include abdominal cramps, nausea and diarrhea.