What should you know about heart failure orthostatic hypotension?

The change can happen because the heart, blood vessels and nervous system do not maintain blood flow to the brain quickly enough when you stand. Heart failure itself, dehydration, illness and some medicines can contribute. A person with heart failure should not stop or alter prescribed treatment without speaking with a clinician.

Orthostatic, or postural, hypotension is a fall in blood pressure when moving from lying or sitting to standing. It may cause light-headedness, blurred vision, weakness, nausea, unsteadiness or fainting. The symptoms often appear soon after standing and may improve when you sit or lie down.

In heart failure, the body may have less reserve to adjust circulation during a position change. Water tablets and other medicines may also lower blood pressure or reduce circulating fluid, even when they are helping control heart-failure symptoms. Only a clinician can work out which factor is responsible.

Move in stages: sit on the edge of the bed, pause, then stand while holding a stable surface. Avoid rushing up after lying down, and sit or lie down promptly if you feel faint. Keep walkways clear and use support if your balance is poor.

Arrange a review of your heart-failure medicines, blood pressure and fluid plan. Do not increase fluids or salt on your own: those changes may worsen swelling or breathlessness in heart failure. Keep a record of when symptoms occur, your position, recent illness, and any home blood-pressure readings taken as instructed.

Seek urgent medical help for fainting, chest pain, severe or new breathlessness, blue or grey lips, confusion, a serious fall, or symptoms that do not settle after lying down. These signs can reflect a heart problem, a dangerous blood-pressure drop or another emergency.

Contact your heart-failure team or a GP promptly if dizziness is recurring, you are nearly fainting, your readings are repeatedly lower than the range given to you, or you have vomiting, diarrhoea, fever, worsening swelling or a noticeable change in urine. A clinician may check your blood pressure in different positions, examine you and review medicines.

Ask which medicine or health change could be contributing, what blood-pressure readings should prompt a call, and how to balance your fluid advice with dizziness. Also ask whether you need an assessment of your heart rhythm, blood count or kidney function, based on your symptoms and medical history.