Orthostatic Hypotension vs. POTS: Understanding the Key Differences

When patients experience dizziness or lightheadedness upon standing, two possible culprits often come to mind: Orthostatic Hypotension (OH) and Postural Orthostatic Tachycardia Syndrome (POTS). While both conditions fall under the umbrella of autonomic dysfunction and can appear similar on the surface, they are distinct in their causes, diagnostic criteria, and treatments. Understanding the key differences between orthostatic hypotension vs POTS is crucial for proper diagnosis and effective management.

What is Orthostatic Hypotension?

Orthostatic Hypotension is a form of low blood pressure that occurs when standing up from a sitting or lying position. It is defined by a drop of at least 20 mm Hg in systolic blood pressure or 10 mm Hg in diastolic pressure within three minutes of standing.

Common Symptoms of OH:

• Lightheadedness or dizziness upon standing
• Blurry vision
• Weakness
• Fainting (syncope)
• Nausea

Orthostatic hypotension is often related to aging, dehydration, blood loss, or the side effects of medications. It can also be a symptom of underlying conditions like diabetes or Parkinson’s disease.

What is POTS (Postural Orthostatic Tachycardia Syndrome)?

POTS is a condition where the heart rate increases significantly—by 30 beats per minute or more (or over 120 BPM in adolescents)—within 10 minutes of standing, without a significant drop in blood pressure. Unlike orthostatic hypotension, the blood pressure remains relatively stable, but the autonomic nervous system overreacts to postural changes.

Common Symptoms of POTS:

• Rapid heart rate upon standing
• Dizziness or near-fainting
• Brain fog
• Fatigue
• Palpitations
• Shakiness or anxiety
• Gastrointestinal discomfort

POTS primarily affects young women and is often associated with other conditions like Ehlers-Danlos syndrome, autoimmune disorders, or viral illnesses.

Orthostatic Hypotension vs POTS: Key Differences

While orthostatic hypotension and POTS can cause similar symptoms like dizziness and fatigue upon standing, the way these conditions affect the body is quite different.

In orthostatic hypotension, the primary issue is a drop in blood pressure. When someone stands up, their blood pressure drops significantly—typically by at least 20 mm Hg systolic or 10 mm Hg diastolic. This leads to reduced blood flow to the brain, resulting in lightheadedness or even fainting. The heart rate may remain normal or only slightly increase as the body tries to compensate.

In contrast, POTS is marked by an exaggerated increase in heart rate rather than a drop in blood pressure. Upon standing, the heart rate jumps by at least 30 beats per minute (or exceeds 120 bpm), even though the blood pressure remains relatively stable. This rapid heart rate is the body’s response to faulty autonomic regulation and can lead to palpitations, shakiness, and extreme fatigue.

The two conditions also differ in age demographics. Orthostatic hypotension is more common in older adults, often related to medication side effects, dehydration, or chronic illnesses. POTS, on the other hand, tends to affect younger individuals, especially women, and may follow a viral illness or coexist with conditions like Ehlers-Danlos syndrome or autoimmune disorders.

Diagnosing these conditions usually involves tilt-table testing and monitoring heart rate and blood pressure changes with position. Treatment for orthostatic hypotension focuses on stabilizing blood pressure through hydration, compression stockings, and medication adjustments. POTS treatment often centers around managing heart rate, increasing fluid and salt intake, and gradually building physical stamina.

By understanding these key differences, both patients and providers can better navigate the path toward effective symptom relief and improved quality of life.

Diagnosis and Treatment

Accurate diagnosis requires a comprehensive clinical evaluation, which may include:

• Tilt-table testing
• Continuous blood pressure and heart rate monitoring
• Blood volume assessments
• Lab work to rule out other causes

Treatment for OH often includes:

• Increasing fluid and salt intake
• Compression stockings
• Medication adjustments

POTS treatment may involve:

• Hydration and electrolyte support
• Gradual physical reconditioning
• Medications like beta-blockers or fludrocortisone

When to See a Specialist

If you’re experiencing persistent symptoms like dizziness, fainting, or rapid heartbeat upon standing, it’s important to seek evaluation from a specialist in autonomic or cardiovascular disorders. At Bloomfield Vein & Vascular, PLLC, we specialize in diagnosing and treating a wide range of vascular and circulatory conditions, including orthostatic hypotension and POTS.

Take Control of Your Symptoms – We’re Here to Help

If you’ve been struggling with unexplained dizziness, rapid heart rate, or fainting spells when standing, don’t ignore the signs. Whether it’s orthostatic hypotension or POTS, getting the right diagnosis is the first step toward feeling like yourself again.

At Bloomfield Vein & Vascular, PLLC, our expert team specializes in identifying and treating circulatory and autonomic conditions with personalized care and advanced diagnostic tools. We’ll help you understand what’s really going on—and create a treatment plan tailored to your body’s unique needs.

Call us today or  request an appointment online to start your journey toward better health. You don’t have to live with uncertainty—we’re here to guide you every step of the way.