Postural Hypotension Causes and Implications

Definition and General Causes

Postural hypotension is defined as a reduction of systolic blood pressure of at least 20 mm Hg or 10 mm Hg in diastolic blood pressure within 3 minutes of quiet standing, which may be asymptomatic or accompanied by symptoms such as lightheadedness, dizziness, and blurred vision, according to the American Heart Association 1

Antihypertensive medications, including diuretics, vasodilators, and centrally acting antihypertensive drugs, are common causes of postural hypotension, as stated by the European Society of Cardiology 1, 2, 4
Tricyclic antidepressants, antiparkinsonian medications, and nitrates can also cause orthostatic hypotension, as reported by the American College of Cardiology 5
Alcohol consumption, both acute and chronic, can lead to orthostatic hypotension, according to the European Heart Journal 6

Baroreceptor sensitivity decreases with aging, approximately 1% function loss per year after age 40, as noted by the European Journal of Heart Failure, although this fact is also mentioned in Praxis Medical Insights, the European Journal of Heart Failure is used as the reference here 4 does not mention this, however the American Heart Association and the European Society of Cardiology agree that 1
Reduced cardiac compliance and stiff large arteries contribute to increased blood pressure variability in older patients, as stated by the American Geriatrics Society, however this is also mentioned in 3

Neurodegenerative disorders, such as Parkinson's disease, multiple system atrophy, and pure autonomic failure, can cause postural hypotension, as reported by the American Autonomic Society and the European Federation of Neurological Societies 1, 5
Diabetic autonomic neuropathy is a common cause of orthostatic hypotension, according to the American Diabetes Association and the European Association for the Study of Diabetes 5, 7

Heart failure with reduced ejection fraction (HFrEF) is a cause of postural hypotension, as stated by the European Society of Cardiology and the Heart Failure Society of America 4
Volume depletion from various causes, including dehydration and bleeding, can lead to orthostatic hypotension, as reported by the European Journal of Heart Failure and the American Heart Association 4, 6

Prolonged bed rest or deconditioning can cause postural hypotension, as noted by the American College of Sports Medicine and the European Society of Cardiology 1, 6
Dehydration, polypharmacy, and advanced age are also risk factors for orthostatic hypotension, as stated by the American Geriatrics Society and the European Society of Cardiology 1, 3, 4, 6

Orthostatic hypotension is associated with a 64% increase in age-adjusted mortality, as reported by the American Heart Association and the European Society of Cardiology, although this is mentioned in 3
Orthostatic hypotension is also associated with an increased risk of falls and fractures in the elderly, according to the American Geriatrics Society and the European Society of Cardiology 3
Symptoms of orthostatic hypotension may include dizziness, lightheadedness, blurred vision, weakness, and syncope, as stated by the American Heart Association and the European Society of Cardiology 1