Feeling Light-Headed When You Stand Up? Let’s Talk About Postural Hypotension | Rodolico Health

Feeling Light-Headed When You Stand Up? Let’s Talk About Postural Hypotension | Rodolico Health

I am very grateful to my colleague and friend Dr Surangi Mendis, a dizziness specialist (audiovestibular and neuro-otology consultant) in London and a fellow clinician at the National Migraine Centre, for contributing to this month’s mid-month blog post.

Her specialty is unusual — and incredibly valuable — because dizziness overlaps with so many areas of medicine, including migraine, balance disorders, neurological conditions, and general practice. Having her insight gives a broader clinical perspective when thinking about symptoms many of us see frequently in primary care.

Although dizziness can be a symptom of many conditions, one of the most common — and least recognised — causes is something called postural hypotension. It affects people all year round, but here in Italy, with significant seasonal changes and intense summer heat, it’s especially relevant.

What Is Postural Hypotension?

Postural hypotension (also known as orthostatic hypotension) is a drop in blood pressure that occurs when moving from lying or sitting to standing.

Normally, your body adjusts quickly to keep blood flowing to your brain. When this adjustment doesn’t happen properly, blood pressure drops — and symptoms may follow.

Common symptoms include:

  • Light-headedness or dizziness when standing

  • Blurred vision

  • Weakness or fatigue

  • Feeling faint or actually fainting (syncope)

  • A sensation of a “head rush” or unsteadiness

This can happen occasionally to anyone, but if it’s frequent or worsening, it’s important to have it reviewed.

Who Gets It?

Although more common in older adults, postural hypotension can affect people of any age. Risk factors include:

  • Parkinson’s disease or other neurological conditions

  • Autonomic dysfunction (difficulty regulating blood pressure)

  • POTS (Postural Orthostatic Tachycardia Syndrome), often affecting younger people

  • Diabetes or low blood volume

  • Dehydration or recent illness

  • Post-viral symptoms, including Long COVID

  • Medications that lower blood pressure

  • Polypharmacy (taking multiple prescriptions)

If you are unsure whether your symptoms fit this picture, a GP review is the right first step. Book an appointment here

A Simple Test You Can Try at Home

If you have a home blood pressure monitor, you can try this:

  1. Lie down and rest for five minutes.
    → Record your blood pressure and pulse.

  2. Stand up slowly.

  3. Repeat the measurements at 1 minute and 3 minutes after standing.

A drop in systolic blood pressure ≥ 20 mmHg, or diastolic ≥ 10 mmHg, may indicate postural hypotension.

If you don’t have a monitor, recurrent dizziness on standing is still something you should discuss with your GP.

Why It Happens

In many people, especially older adults, postural hypotension is linked to:

  • Medications for blood pressure or heart conditions

  • Dehydration

  • Recent illness

  • Chronic conditions affecting the nervous system

  • Age-related changes in blood pressure regulation

If left unmanaged, it can increase the risk of falls, injury, and reduced independence — which is why early recognition matters.

What You Can Do at Home

These strategies may help reduce symptoms:

1. Change position slowly

Rise from bed or a chair in stages — sit, pause, then stand.

2. Front-load your fluids

Drink more fluids earlier in the day; dehydration worsens low blood pressure.
Top tip: Keep a bottle of water beside your bed and drink before standing in the morning.

3. Use compression hosiery

Medical compression stockings can help stop blood pooling in the legs.
Your GP or pharmacist can advise on the right type and fit.

4. Review your caffeine intake

Limit to 1–2 cups of tea or coffee per day. Excess caffeine can worsen dehydration.

5. Keep moving

Before standing, gently move your legs and ankles to encourage circulation.

6. Medication review

A GP or pharmacist can check whether any of your medications are contributing to low blood pressure.

When to See Your GP

Please don’t ignore symptoms that are:

  • New

  • Frequent

  • Causing falls

  • Getting worse

Your GP can:

  • Check your blood pressure lying and standing

  • Review your medications

  • Investigate underlying causes

  • Refer to a specialist if needed

Postural hypotension is common, but it is not something you must simply “put up with.”
With the right support, many people experience a significant improvement in symptoms.

If you're concerned about dizziness or fainting, you can book an appointment at Rodolico Health for a full assessment.

Book a Preventive Health Check
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