Orthostatic Hypertension or Orthostatic Hypotension

What is Orthostatic Hypotension?

Orthostatic intolerance is a marked increase in symptoms when standing that gets better when sitting or lying down. One form of orthostatic intolerance is orthostatic hypotension, also referred to as postural hypotension. Orthostatic hypotension is a drop in blood pressure when a person stands up. This drop in blood pressure is due to the blood concentration in the lower half of the body due to gravity and the body not adequately addressing this change. A small decrease is normal when changing positions and the body uses several mechanisms to keep things running smoothly, involving the cardiac, neurological, and vascular systems. If one of these systems do not respond correctly, the blood pressure is not automatically corrected as it should.

Symptoms range from mild to severe and can include dizziness, headache, confusion, nausea, and fainting. Patients may experience anxiety and difficulty thinking, which is often particularly pronounced when experiencing rapid changes over some time.

Both forms of orthostatic intolerance share similar causes. People with dysautonomia, autonomic nervous system dysfunction, may experience both conditions at various times as the autonomic nervous system is not regulated correctly. People who are immobile because of age, weakness, surgical recovery, or illness are also prone to developing the disorder.

What is Orthostatic Hypertension?

Another form of orthostatic intolerance is orthostatic hypertension. Orthostatic hypertension, otherwise known as postural hypertension, is a rise in blood pressure when a person goes from laying down or sitting to standing. This increase must be over 20 mm Hg to be considered orthostatic hypertension.

Symptoms of orthostatic hypertension are similar to symptoms of general hypertension: dizziness, headache, chest pain, vision changes, fatigue, and confusion. If the condition is mild, the person may not be aware of the increase and may not experience any symptoms.

Orthostatic hypotension can be idiopathic (with no known cause) or the result of medications, lifestyle, or underlying medical conditions.


Diagnosis of orthostatic hypertension and orthostatic hypotension is made in the same way. A patient is examined in a doctor’s office, and their blood pressure and heart rate are taken while sitting and then while standing.

Diagnosis can also be made with a tilt table test, where a patient is strapped to a table that is then slowly raised, so the patient is in a standing position. Blood pressure readings are taken while the table is in several positions. Tilt table testing is preferred when a patient is very prone to fainting or falls as the straps prevent the patient from falling.

A diagnosis of orthostatic hypotension requires that when standing the systolic blood pressure drop by at least 20 mm Hg or the diastolic blood pressure to drop by 10 mm Hg. If the change is within 30 seconds to 3 minutes, it is considered to be classic orthostatic hypotension. If it takes longer than 3 minutes for the change to occur, it is considered to be the delayed type. Initial orthostatic hypotension is a type that occurs almost instantly and then is quickly corrected, making it challenging to observe.


Lifestyle changes are an essential part of treating orthostatic hypertension or hypotension. Avoiding quick changes in posture is important. Exercise, often under the supervision of a physical therapist, can build the body’s tolerance for postural changes. Medications to raise or lower the blood pressure and maintain blood volume are treatments for both conditions.

People with orthostatic hypotension may increase their salt consumption, wear compression garments to return blood flow from the extremities, and raise the head of the bed to maintain blood volume when sleeping. Alcohol, which exacerbates symptoms, should be avoided.

Chronic orthostatic intolerance can lead to falls, which can cause traumatic brain injuries or death. If the condition goes on for an extended time, it can lead to increased risk of stroke and cardiovascular issues.

Disability Evaluation

Some people can’t work because of their orthostatic hypertension or hypotension. People who cannot work must apply for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.

Definition of Disability

Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to complete the work duties of almost any occupation for the years following the initial 2-year period. Some plans are a bit different, so it’s essential to understand your specific policy and its limitations when applying for benefits.

Evaluating Disability Eligibility

Evaluation of eligibility for long-term disability benefits depends on the severity of symptoms, how they are likely to affect a person’s ability to work, and the duration of symptoms. The more a person is affected, the more likely they are to be considered disabled.

Because postural changes exacerbate both conditions, a job that requires a lot of movement or changes in position may be impossible. Even simple things like bending and lifting may cause an episode. Someone who suffers from severe confusion may not even be able to handle a sedentary job. If someone has frequent falls or syncope episodes, they may be a liability to have on the premises of any business.

If someone is not considered disabled because of their orthostatic hypertension or hypotension, they may still be eligible if they have other conditions that are considered disabling. Evaluators look at a person’s entire medical health when deciding, so it is vital to list all relevant medical conditions when applying for benefits.

What the Insurance Company Needs from You and Your Medical Providers

You will need to tell the insurance company about any doctors that have treated you for your condition. They will need to get your medical records from those doctors when they are evaluating your claim. If the insurance company cannot get those records directly, you may need to get them from your doctors and send them in yourself.

The insurance company will need to see proof of your diagnosis and your ongoing symptoms, as well as evidence of how those symptoms affect your life. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete a correct RFC for you.

Working with a Disability Attorney

You do not have to fight the insurance companies alone. An experienced disability attorney will guide you through the process and give you the best chance of getting the benefits you deserve for your orthostatic intolerance. Even if you have already applied and received a rejection, you are not out of luck.

The experienced disability attorneys at the Ortiz law firm can help you through every step of the process, from administrative appeals to potential litigation. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.

The Ortiz law firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your orthostatic hypertension or hypotension and how it affects your life, call us at (888)321-8131.


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