Orthostatic hypotension: symptoms, causes and natural solutions

What is orthostatic hypotension?

Orthostatic hypotension is defined as a sudden drop in blood pressure when moving to a standing position, generally within three minutes of changing position (1).

This drop in blood pressure prevents proper blood flow to the brain, which can lead to a number of symptoms:

• dizziness or a feeling of lightheadedness
• blurred vision or a temporary dimming of sight
• a sudden feeling of tiredness, or even faintness
• loss of balance, which may lead to a fall

Chronic hypotension (low blood pressure on a daily basis, sometimes well tolerated) should not be confused with orthostatic hypotension, which occurs specifically when there is a change in posture.

The two are not necessarily linked: a person with usually low blood pressure may never suffer from orthostatic hypotension, and vice versa.

What causes orthostatic hypotension?

Orthostatic hypotension can have many causes, often combined:

• dehydration: excessive loss of fluids (profuse sweating, diarrhoea, fever, heat, use of diuretics) leads to a drop in blood volume and weakens blood pressure regulation;
• electrolyte deficiency: a lack of sodium, potassium or magnesium in the body also increases the risk of orthostatic hypotension;
• reduced vascular tone: with age, the walls of the blood vessels become less reactive. This makes it harder for the arteries and veins to contract rapidly to compensate for the change to standing;
• taking blood pressure-lowering drugs: certain treatments for hypertension, antidepressants, neuroleptics and diuretics can induce episodes of orthostatic hypotension;
• neurological disorders: damage to the autonomic nervous system, which is responsible for regulating blood pressure, can lead to adaptation difficulties;
• nutritional deficiencies: a lack of vitamin B12, iron or folates can weaken the production of red blood cells and limit cerebral oxygenation, increasing the risk of orthostatic hypotension.

The profiles most at risk include:

• the elderly, whose cardiovascular regulation system is less effective
• people who are dehydrated, particularly in hot weather
• patients with multiple medications
• people suffering from certain chronic diseases (Parkinson's, diabetes, heart failure, etc.)

Natural solutions and practical advice

While some simple measures can help prevent or limit attacks, medical advice is always essential in cases of orthostatic hypotension (to identify the cause of the problem and avoid any complications).

Adopt simple daily habits

In the event of sudden vertigo, the first priority is to sit down or lie down immediately, with your legs slightly elevated, to promote the return of blood to the brain. Then breathe calmly and wait a few moments before getting up again.

On a daily basis, a number of simple measures can help reduce the frequency and intensity of orthostatic hypotension episodes:

• get up gradually (sit up first, then move to a standing position)
• drink enough water throughout the day
• eat smaller, more frequent meals (avoiding overly large portions)
• move your legs slightly before getting up
• avoid standing still for too long
• raise the head of your bed slightly
• wear compression stockings if necessary
• with your doctor's agreement, slightly increase the salt content of your diet

When should you seek medical advice?

If episodes of orthostatic hypotension become frequent, it is important to consult your doctor.

The doctor will begin by measuring your blood pressure while you are sitting and then standing, and will check the impact of any medication you are taking.

The doctor may also look for any underlying causes, such as anaemia, dehydration or a neurological disorder.

Food supplements: options to be considered with medical advice

Reduction of fatigue, maintenance of normal blood pressure, normal formation of red blood cells and support for cardiovascular function or metabolism... Although they do not replace medical supervision, certain nutrients and plants are being studied for their potential effects on the causes and symptoms of orthostatic hypotension (2-5).

Their use should always be approved by a health professional, especially if you are taking medication.

Electrolytes and magnesium

Taking electrolytes can be a good idea if you are losing a lot of minerals through sweating or heat.

Potassium is an important mineral for the body, helping to maintain normal blood pressure.

Magnesium contributes to electrolyte balance and the normal functioning of the nervous and muscular systems. And an adequate intake of magnesium can help maintain normal blood pressure.

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Vitamin B12 and folates

Vitamin B12 contributes to the normal formation of red blood cells, and vitamin B9 (or folates) to the normal formation of blood.

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Ginseng

Traditionally used in Chinese medicine, ginseng may help reduce fatigue and exhaustion.

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Coenzyme Q10

A key cofactor in energy production in cells, coenzyme Q10 is being studied for its potential role in fatigue and heart function (6).

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Vitamin C and alpha-lipoic acid

Vitamin C contributes to normal energy metabolism, normal nervous system function and reduced fatigue.

Alpha-lipoic acid is an antioxidant that has been studied for its potential effects on energy metabolism (7).

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Essential precautions to be aware of

Orthostatic hypotension can be benign, but it can also be indicative of an underlying problem.

Before considering supplementation, it is essential to:

• consult a doctor to identify the real cause of the hypotension
• avoid supplements likely to lower blood pressure
• monitor blood pressure regularly
• only adjust your intake on medical advice, particularly if you are taking antihypertensive, diuretic or neurological medication