Orthostatic Dysregulation – Causes, Symptoms & Treatment

Orthostatic Dysregulation

Orthostatic dysregulation is a regulatory disorder of blood pressure. It occurs when the affected person assumes an upright posture.

What is orthostatic dysregulation?

Orthostatic dysregulation is also known in medicine as orthostatic syndrome or orthostatic hypotension . What is meant by this is a regulatory disorder of blood pressure when the person changes to an upright body position.

The term orthostasis comes from the Greek and means “standing upright”. The orthostatic dysregulation is counted among the forms of arterial arterial hypotension . There is a malfunction of the orthostatic reaction, which in healthy people ensures that the cardiovascular system works properly even in an upright position.

However, orthostatic hypotension results in symptoms such as tachycardia, feelings of weakness , dizziness and nausea when the person assumes an upright posture. If the person concerned sits or lies down again, the symptoms quickly subside.

Medicine divides the regulatory disorder into three forms:

  • that sympathikotonic orthostatic hypotonia
  • that asympathikotonic orthostatic hypotonia
  • das postural orthostatic Tachykardiesyndrom.


While the term hypotension refers to low blood pressure, orthostatic hypotension refers to an abrupt drop in blood pressure after standing up. This process causes blood to flow from the head towards the feet. As a reaction to this process, the heart beats faster and the blood vessels contract, causing the blood pressure to rise rapidly.

The organism can return the blood to the head in a short time. However, if this reaction starts too slowly, it causes insufficient blood flow to the brain for a short period of time, making the affected person feel light-headed. Postural dysfunction is not a life-threatening disorder, but it can sometimes lead to loss of consciousness and even a fall with injury.

It is not uncommon for increased age to be responsible for orthostatic dysregulation. Over the years, the body partially loses the ability for an orthostatic reaction. However, certain diseases are also considered a risk factor for orthostatic syndrome. These primarily include diabetes ( diabetes mellitus ) and diseases that affect the nerves that are important for blood pressure regulation.

Another possible cause of orthostatic dysregulation is the use of certain medications. These are medicines that act against high blood pressure and ensure vasodilatation. In addition to blood pressure medication, there are also diuretics , cytostatics , drugs to treat Parkinson’s disease, and hypnotics .

But tranquilizers, tricyclic antidepressants , opiates , psychotropic drugs , insulin , muscle relaxants, alcohol and drugs such as marijuana can also trigger orthostatic syndrome. Other conceivable causes are heart and blood vessel diseases such as heart failure or pericarditis .

Also, a narrowing of the aorta or heartbeat disorders, infections, an underactive thyroid gland , malfunctions of the anterior pituitary gland and adrenal cortex , permanent lack of exercise , prolonged bed rest and a lack of fluids .

Symptoms, Ailments & Signs

Orthostatic dysregulation is characterized by non-specific symptoms. As a rule, they appear after a sudden change in position of the body, which mainly affects getting up after lying down. If the person concerned stands for a longer period of time, the symptoms can intensify.

The general symptoms are a feeling of cold, nausea , pallor , sweating and inner restlessness . In addition, there is often tachycardia, a feeling of anxiety, dizzy spells, headaches , drowsiness, unsteadiness when walking and standing, ringing in the ears , flickering eyes and a feeling of emptiness in the head.

Because of the discomfort, the patient is forced to sit or lie down again. In this case, the symptoms usually disappear quickly. In some cases, however, a brief faint is possible, which poses the risk of a serious fall and associated injuries.

Diagnosis & disease progression

Suspicion of orthostatic dysregulation usually arises from the patient’s medical history. In order to secure the diagnosis, the attending physician usually carries out a tilt table examination or a Schellong test. During the Schellong test, the patient remains on an examination table for five to ten minutes while their blood pressure and heart rate are measured.

He should then get up quickly and stand still for five to ten minutes. Pulse and blood pressure are also checked during this period. In the tilt table test, the doctor straps the patient to a table that can be tilted. After a rest period of twenty minutes, he tilts the table and uses it to stand the patient up.

After assuming a standing position for twenty minutes, the table is tilted back again and the process repeated. In most cases, orthostatic dysregulation takes a positive course. The symptoms improve again in around 80 percent of all patients.


In most cases, this disease does not lead to any special complications and, as a rule, does not lead to a life-threatening condition. The symptoms and complaints can occur to different degrees in different patients. As a rule, however, most people affected by this disease suffer from paleness and nausea. Headaches and blurred vision occur after changing positions.

A flickering of the eyes or ringing in the ears can also occur. Unsteadiness occurs when walking, and people appear dazed and confused. The symptoms usually disappear relatively quickly when the patient lies down or sits down. There are no particular complications. However, in severe cases, the patient may lose consciousness, possibly injuring themselves.

Treatment of the disease is only necessary in severe cases. This is done with the help of medication and does not lead to further complications. If another underlying disease is responsible for these symptoms, it must be treated first. As a rule, the life expectancy of the person affected is not reduced due to the illness.

When should you go to the doctor?

People who experience discomfort after a sudden or rapid change in body position should consult a doctor. If there is pale skin, discomfort, or nausea immediately after the movement is performed, there is cause for concern. If you experience flickering eyes, dizziness or loss of balance, you should consult a doctor to avoid sequelae or other problems. Ringing in the ears, headaches or a feeling of emptiness should be examined. If there are disturbances in the heart rhythm, a racing heart develops or there is a loud pounding of the heart, a doctor is needed.

In the case of drowsiness after getting up or bending over, the clarification of the symptoms is necessary. A brief loss of consciousness should be reported to a doctor immediately. If possible, the rescue service should be alerted so that the state of health of the person concerned can be stabilized as quickly as possible. A feeling of cold, unsteady gait or an increased risk of accidents should be presented to a doctor.

If fears develop, withdrawal behavior develops or if movements are almost completely avoided, the person concerned needs help. If the symptoms increase or new symptoms arise, a doctor’s visit is strongly recommended. The existing inconveniences often increase as soon as the person concerned stands for a certain time and then changes their body position.

Treatment & Therapy

As far as possible, orthostatic dysregulation should be treated without the administration of medication. Only in severe cases does the patient receive alpha-adrenoceptor agonists. To counteract the hypotension that mostly occurs in the morning hours, it is recommended to do cardiovascular exercises when getting up.

The venous return flow can be stimulated by activating the muscles of the lower leg while lying down. Before getting up, the person concerned can remain seated for two minutes. A cool environment is also considered helpful, since the cold also increases venous return. A strong cup of coffee can often help.

Outlook & Forecast

In the case of orthostatic dysregulation, the prognosis varies. Sympathicotonic orthostatic hypotension has a positive prognosis. They are easily treatable. In contrast, the asympathicotonic form of this disease is a serious disease with a poor prognosis.

In the case of sympathicotonic orthostatic dysregulation, the affected person can lead a relatively normal life. However, he should take various measures to ensure his health. It cannot be ruled out that otherwise a deterioration or a cardiovascular disease will occur. Physicians disagree on the extent to which orthostatic dysregulation is merely a nuisance or the harbinger of later cardiovascular disease.

In general, low blood pressure is not noticed because it has a damaging effect on vessels. He can cause complaints, but also grant freedom from complaints. Measures that improve the prognosis are helpful. For example, patients should consume more fluids and salt. You should stop taking medications that promote orthostatic hypotension. Everyone can do a lot to keep the blood vessels healthy, for example through sport, Kneipp treatments or brush massages. Those affected with orthostatic dysregulation can do a lot to positively influence the prognosis. Drug therapies are only necessary if your own measures are not sufficient.

The asympathicotonic variant of orthostatic dysregulation is a chronic progressive form. This is difficult to control with therapeutic measures.


In order to prevent problems caused by orthostatic dysregulation, getting up slowly and not too quickly is recommended. Sleeping with your upper body elevated is also considered sensible.


Orthostatic dysregulation is a condition that often depends on the behavior of the patient. Follow-up care is prevention at the same time, so that the disorder occurs as rarely as possible in those affected. There is a whole bundle of measures that are used in aftercare and can be discussed in advance with the doctor treating you, for example your general practitioner.

Movement is an important factor in stabilizing the circulatory system in the long term. Here, the individual aftercare for orthostatic dysregulation offers two efficient building blocks: On the one hand, it is important to keep moving briefly during the day to activate the circulation, for example getting up from the computer at your desk and doing a few gymnastic exercises .

Furthermore, consistent physical training is important. Strength training and fitness courses are just as possible as swimming or games. Regular circulation activation is the only thing that is important. Drinking behavior is also important in the context of aftercare for orthostatic dysregulation. Not drinking enough can lead to dehydration, which can promote circulatory problems.

Water and teas are particularly suitable as regular drinks. On the other hand, it is better to avoid alcohol, especially in large quantities. Nicotine can also have an adverse effect. When it comes to meals, care can be taken not only to burden the organism with large portions, but rather to eat light food more frequently during the day.

You can do that yourself

After the medical diagnosis and treatment, self-help for the disease is primarily about reducing the symptoms and improving the quality of life. This increase is possible by paying attention to a few aspects in everyday life.

Since standing for a long time can be problematic, but cannot always be avoided, compression stockings are ideal for such situationsa big help. Due to the pressure on the veins and muscles in the legs, the blood cannot pool in the legs as quickly. This reduces the risk of a sudden drop in blood pressure. Furthermore, in the case of orthostatic dysregulation, it is advisable to change position slowly. After sleeping, it is advisable to remain seated for a moment. It is also helpful to get up very slowly after sitting for a long time. This also reduces the risk of blood pooling in the legs and the symptoms of orthostatic dysregulation. Staying in very warm rooms or even when bathing is particularly critical. In these cases, care should also be taken to avoid standing for long periods or getting up quickly.

Contrast showers can help to reduce the sensitivity of the nervous system . This means that when showering, the water temperature should be alternated between warm and cold. It is most effective if the phase with cold water lasts about 30 seconds and the leg region is preferably showered. Exercise and diet also have a significant impact. Eating a diet high in salt can generally increase blood pressure somewhat, and building good leg muscles helps the body function naturally.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.