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Orthostatic Hypotension NPTE Studycast

Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS

Notes by Alexis Lancaster, SPT

What is it

  • A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position


  • Cardiovascular system, BP, blood supply to the brain

Signs & Symptoms:

  • Physical signs: pallor, diaphoresis, loss of consciousness (potentially)
  • Symptoms pt will report: dizziness, light-headedness, faintness, nausea

Differential Diagnosis:

  • Autonomic dysreflexia
  • Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP
  • Vertigo, BPPV: b/c of dizziness and light-headedness symptoms
  • Generalized nausea from infection, etc.

Special tests

  • Orthostatic testing: monitor BP with position changes

Treatment examples:

  • Immediately: lay the person down, elevate legs to prevent loss of consciousness
  • After: talk to the team about BP treatment medications
  • Encourage fluids with pt
  • Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes
  • Abdominal binders, ace wraps on legs to keep BP up

How can it look on the test?

  • The important part: recognizing OH and manage it
  • Emergent scenario: decide that it’s OH and what you would do about it
  • May need to differentiate between OH and more emergent conditions, such as AD