Orthostatic hypotension, the drop in blood pressure that happens when you stand up, is treatable with a combination of everyday habit changes, physical techniques, and sometimes medication. Most people start with non-drug approaches, which can be surprisingly effective on their own. The condition is defined by a blood pressure drop of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing, and treatment aims to shrink that gap enough to eliminate dizziness, lightheadedness, and fainting.
Water and Salt: The First-Line Approach
Drinking a large glass of water quickly is one of the simplest and most effective treatments. Research published in Neurology found that bolus water drinking (consuming about 16 ounces in a short period) should be the standard first-line non-drug intervention. The effect kicks in within minutes, raising blood pressure by expanding blood volume.
Increasing salt intake works alongside extra fluids. Guidelines from multiple cardiovascular and heart rhythm societies recommend between 6,000 and 10,000 mg of salt per day (roughly 2,400 to 4,000 mg of sodium) for people with orthostatic disorders. Some recommendations go even higher, up to 12,000 mg of salt daily. For context, the typical healthy-adult guideline caps sodium at 2,300 mg per day, so this is a significant and intentional increase. People often accomplish it by adding 1,000 to 2,000 mg of sodium to meals three times a day through salt tablets or simply salting food more liberally. This approach only works if you’re also drinking enough fluid to match.
Physical Counter-Maneuvers That Work Immediately
When you feel lightheaded after standing, certain body positions can buy your circulatory system time to catch up. The most studied technique is crossing your legs while tensing your thigh and abdominal muscles. In tilt-table testing, this maneuver raised mean arterial pressure by 13 mmHg, increased the amount of blood the heart pumped per beat by 27%, and boosted leg blood flow by 325 ml per minute. Those are meaningful numbers that can be the difference between staying upright and passing out.
Other useful maneuvers include squatting, clenching your fists, and marching in place. The goal is always the same: squeeze blood from your legs and abdomen back toward your heart. These techniques cost nothing, carry no side effects, and work within seconds. They’re especially useful as a bridge while longer-term treatments take effect.
Compression Garments: What Actually Helps
Not all compression is created equal. Abdominal compression belts were effective in 52% of patients studied and raised standing systolic blood pressure by about 10 mmHg. Thigh-high compression stockings, by contrast, were the least effective option, helping only 32% of patients with a modest 6 mmHg improvement that wasn’t statistically significant. Researchers at Neurology concluded that compression stockings should be disregarded in this population.
If you’re going to use compression, an abdominal binder is the better choice. It works by preventing blood from pooling in the large vascular bed of your abdomen when you stand. It’s also more comfortable and easier to put on than full-length stockings, which makes people more likely to actually wear it.
Sleeping Position Matters
Elevating the head of your bed by about 10 degrees (roughly 9 inches) can reduce morning symptoms. When you sleep completely flat, your body responds to the increased blood return by producing more urine overnight, which reduces blood volume. By morning, you’re effectively dehydrated, making the blood pressure drop when you first get up even worse. A slight incline keeps mild gravitational stress on the system all night, reducing that overnight fluid loss and helping your body retain the volume it needs for the morning transition to standing.
Medication Review
Before adding new medications, it’s worth examining whether existing ones are contributing to the problem. Blood pressure medications, diuretics, certain antidepressants, and prostate medications can all worsen orthostatic hypotension. Adjusting the timing or dosage of these drugs, or switching to alternatives, sometimes resolves the issue entirely.
Medications That Raise Standing Blood Pressure
When lifestyle changes aren’t enough, two medications are most commonly prescribed. Midodrine works by stimulating nerve endings in blood vessels, causing them to tighten and raising blood pressure. It’s typically taken three times during the day in roughly four-hour intervals: upon waking, at midday, and in the late afternoon. The last dose should be taken no later than about 6 p.m. because raising blood pressure while lying down at night can be harmful.
Fludrocortisone takes a different approach. It helps your kidneys retain sodium, which pulls more water into your bloodstream and increases overall blood volume. It also makes blood vessels more responsive to the body’s natural tightening signals. People taking fludrocortisone need their potassium levels monitored, since the drug’s sodium-retaining effect can deplete potassium over time.
Both medications share an important risk: they can push blood pressure too high when you’re lying down. This is called supine hypertension, defined as a reading of 140/90 mmHg or higher after five minutes of lying flat. Screening for supine hypertension is recommended for anyone on these medications, which is one reason the timing of doses and sleeping position both matter.
Treatment for Neurogenic Causes
Some people have orthostatic hypotension because the nerves that normally trigger blood vessel tightening are damaged. This neurogenic form is common in Parkinson’s disease, multiple system atrophy, pure autonomic failure, and certain neuropathies. It tends to be more severe and harder to manage than other forms.
For neurogenic orthostatic hypotension, a medication called droxidopa is FDA-approved specifically for the dizziness, lightheadedness, and near-blackout feeling these patients experience. It works by converting directly into norepinephrine, the chemical messenger that tells blood vessels to constrict. Essentially, it replaces what damaged nerves can no longer supply. Droxidopa is approved for adults with symptomatic neurogenic orthostatic hypotension caused by primary autonomic failure, a specific enzyme deficiency, or non-diabetic autonomic neuropathy.
Putting a Treatment Plan Together
Treatment typically follows a layered approach. Start with the basics: rapid water drinking before standing, increased salt intake, sleeping with the head of the bed elevated, and learning physical counter-maneuvers. Add an abdominal compression binder if those aren’t sufficient. Review all current medications for anything that could be worsening the problem. Prescription medications like midodrine or fludrocortisone come next if symptoms persist, and droxidopa enters the picture specifically for neurogenic causes.
Most people need a combination of these strategies rather than relying on any single one. The condition also fluctuates: mornings are typically worse, hot weather makes it worse, and large meals can trigger episodes because blood diverts to the digestive system. Eating smaller, more frequent meals and avoiding alcohol can both help smooth out these swings. The goal isn’t necessarily to eliminate every drop in blood pressure, but to reduce symptoms enough that you can stand and move safely throughout the day.