Dizzy when you stand up?
Often, it’s a blood pressure drop. NICE’s mark is a fall of 20 or more in the top number, or 10 in the bottom, after at least a minute standing. Sitting first can hide it.
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What is orthostatic hypotension?
It’s a drop in blood pressure when you stand up. Its other name is postural hypotension (postural means to do with how your body is positioned).
NICE gives doctors a clear line. Blood pressure is measured in mmHg (millimetres of mercury).
Your top number (systolic) falls by 20 mmHg or more, or your bottom number (diastolic) falls by 10 or more. That’s after at least 1 minute of standing.
So it’s about the step down, not the level. Say you read 130 lying down and 108 standing. That’s a fall of 22, though neither number is low on its own.
It’s common in later life. In studies of people over 60 living at home, about 1 in 5 had it.
| Pattern | What happens | Why it matters |
|---|---|---|
| Postural hypotension | Top number falls 20 or more, or bottom number falls 10 or more, after at least 1 minute standing. | The check NICE uses. Linked to falls in older people. |
| Quick drop | Top number falls more than 40 within 15 seconds, then recovers. | Needs beat-by-beat monitoring. Used to look for causes of fainting in younger adults. |
| Rise on standing | Top number rises 20 or more. | Called orthostatic hypertension if the standing top number is 140 or more. |
Sources: NICE NG136; Saedon 2020; van Wijnen 2017; Jordan 2022
Dizzy most times you stand? Ask your GP or practice nurse for a lying and standing blood pressure check.
Orthostatic hypotension symptoms and causes
The NHS lists these symptoms of low blood pressure: lightheadedness or dizziness, feeling sick, blurred vision, generally feeling weak, confusion and fainting.
If they come on when you stand up or suddenly change position, the NHS says it may be postural hypotension.
| Possible cause | What to do |
|---|---|
| Some medicines | Your GP may change the medicine or its dose. |
| Not eating or drinking enough, or being too hot | Drink more water and eat small, frequent meals. |
| Too much alcohol | Cut back. |
| Some conditions, such as diabetes | Tell your GP if you get dizzy when you stand. |
| Pregnancy | Get up slowly from sitting or lying. |
| Getting older | Ask for a lying and standing check if you feel dizzy or fall. |
Sources: NHS: low blood pressure; NHS: fainting
Dizzy since starting a new prescription? The NHS lists a side effect of medicine as a cause. Ask your pharmacist or GP.
Never stop or change a prescribed medicine without your prescriber.
For other causes, see blood tests for dizziness and how dehydration shows on blood tests.
How is orthostatic blood pressure checked?
The lying and standing check NICE uses
- 1
Lie down
First reading on your back, or sitting if lying is hard.
- 2
Stand up
Second reading after at least 1 minute standing.
- 3
Compare
A fall of 20 or more in the top number, or 10 in the bottom, counts.
- 4
Next steps
Look for causes, review medicines, consider a specialist if symptoms go on after that.
Source: NICE NG136
Sitting first can hide the drop. If a seated check looks fine but you have symptoms, NICE says to repeat it starting lying down.
Still no drop, but still the symptoms? NICE says your GP should think about a specialist check.
NICE also asks GPs to check people with high blood pressure who have type 2 diabetes, have symptoms or are aged 80 and over.
New to the numbers? See blood pressure readings explained and taking blood pressure at home.
Orthostatic hypotension treatment
Treatment starts with the cause. The NHS says medicine to raise blood pressure is rarely needed. Simple changes or treating the cause usually work.
Six NHS habits for dizziness when you stand
- Get up slowly from sitting to standing.
- Getting out of bed, move slowly from lying to sitting to standing.
- Eat small, frequent meals, and lie down or sit still for a while after eating.
- Drink more water.
- Don’t sit or stand for long periods, or bend down or change posture suddenly.
- Don’t drink too much alcohol.
Source: NHS: low blood pressure
Feel a faint coming on? The NHS says lie down with your legs raised, or sit with your head lowered between your knees.
It also suggests crossing your legs while standing, rocking up and down on your toes or clenching your fists.
Your GP may change a medicine or its dose, if that’s the cause. They may suggest support stockings to help your circulation. Never stop or change a prescribed medicine without your prescriber.
What is postural hypertension?
Some people’s blood pressure goes up, not down, when they stand.
Experts call a rise of 20 or more in the top number an exaggerated response. If the standing top number reaches 140 or more, they call it orthostatic hypertension.
Their paper sets out a definition, not symptoms or treatment. The authors hope it helps find people at greater risk of heart and circulation problems.
Standing reading high? Take it to your GP, and see what normal blood pressure is.
Heart racing when you stand is a different problem, covered in our PoTS guide.
When to speak to a GP
Book an appointment if:
- You keep getting dizziness or fainting.
- You have fainted, even once.
- Your dizziness won’t go away or keeps coming back.
- Your face, arms or legs feel numb or weak, or your eyesight changes.
Fainting regularly? You must tell the DVLA (the agency that issues driving licences), as it could affect your driving.
Call 999 if someone who fainted is not breathing or can’t be woken within 1 minute. Also call if they have not fully recovered, or have trouble speaking or moving.
Call too for chest pain, or a pounding, fluttering or irregular heartbeat. The same goes if they’re badly hurt, shaking or jerking, or fainted while exercising or lying down.
Do not drive yourself to A&E.