Orthostatic hypotension (OH), also called postural hypotension, is a condition characterized by a significant drop in blood pressure upon standing.[@hives] It results from impaired autonomic regulation and is particularly prevalent in neurodegenerative diseases, especially synucleinopathies like Parkinson's disease, multiple system atrophy, and Lewy body dementia.
Pathophysiology
Normal Physiology
Baroreceptor activation upon standing
Sympathetic nervous system activation
Vasoconstriction via α-adrenergic receptors
Heart rate increase
Fluid retention mechanisms
Autonomic Failure Mechanisms
Impaired baroreflex function
Reduced sympathetic outflow
Venous pooling
Inadequate vasoconstriction
Neurotransmitter deficiency
Neurodegenerative Causes
Lewy body pathology affecting autonomic centers
Noradrenergic neuron loss
Cardiac sympathetic denervation
Central vs. peripheral mechanisms
Clinical Classification
Classic Orthostatic Hypotension
SBP drop ≥20 mm Hg OR
DBP drop ≥10 mm Hg
Within 3 minutes of standing
Most common in autonomic failure
Delayed Orthostatic Hypotension
Symptoms after 3-10 minutes
Often more subtle
May progress to classic OH
Initial Orthostatic Hypotension
Brief BP drop immediately upon standing
Rapid recovery
Often with vagal symptoms
Associated Neurodegenerative Diseases
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Orthostatic Hypotension
Overview
Orthostatic hypotension (OH), also called postural hypotension, is a condition characterized by a significant drop in blood pressure upon standing.[@hives] It results from impaired autonomic regulation and is particularly prevalent in neurodegenerative diseases, especially synucleinopathies like Parkinson's disease, multiple system atrophy, and Lewy body dementia.
[Multiple System Atrophy](/diseases/multiple-system-atrophy)
[Dementia with Lewy Bodies](/diseases/dementia-with-lewy-bodies)
[Alpha-Synuclein](/proteins/alpha-synuclein)
Recent Research (2024-2026)
This section highlights recent publications relevant to this disease.
[Hives in autonomic disorders: a cutaneous marker of a distinct symptom phenotype.](https://pubmed.ncbi.nlm.nih.gov/41668453/) (2026 Dec) - Annals of medicine
[Impact of COVID‑19 infection on subsequent prescriptions of autonomic dysfunction pharmacotherapy: a nationwide propensity‑score‑matched Cohort study in Japan.](https://pubmed.ncbi.nlm.nih.gov/41560500/) (2026 Dec) - Annals of medicine
[The effect of fludrocortisone and midodrine on ambulatory blood pressure biomarkers and symptoms of syncope.](https://pubmed.ncbi.nlm.nih.gov/41542998/) (2026 Dec) - Blood pressure
[Design and rationale of RECOVER-AUTONOMIC: A randomized platform trial evaluating interventions for Long COVID postural orthostatic tachycardia syndrome.](https://pubmed.ncbi.nlm.nih.gov/41720282/) (2026 Jun) - American heart journal
[Symptomatic Spontaneous Intracranial Hypotension Caused by a Cerebrospinal Fluid Leak at the C1-C2 Level of the Spine Sealed With an Epidural Blood Patch-Case Series and Review of Literature.](https://pubmed.ncbi.nlm.nih.gov/41823091/) (2026 Apr) - Pain practice : the official journal of World Institute of Pain