If you sometimes feel dizzy or lightheaded when you stand up, you’re not alone. Over half of people diagnosed with MS experience low blood pressure when standing up. The scientific term for this is “orthostatic hypotension.” Hypotension means low blood pressure, and orthostatic means it’s related to standing upright. This condition is also known as postural hypotension — low blood pressure related to the position of your body.

So, can MS cause low blood pressure? This article will cover the connection between MS and dizziness when standing up. We’ll also discuss other common causes and how you can manage your symptoms. Your MS specialist can offer their tips as well.

How Do People With MS Experience Low Blood Pressure When Standing Up?

MyMSTeam members often discuss their experiences with orthostatic hypotension. “My last major episode was Friday,” wrote one member. “I woke up and got up to go to the bathroom. Somehow, I landed between the toilet and the wall. I have a very bruised hip, a few dings on my elbow, and a big bump on my head.”

These episodes can be relatively minor or significant enough to warrant a trip to the hospital. One MyMSTeam member shared how one of their episodes of dizziness escalated. “When the EMTs got here,” they wrote, “they couldn’t find a pulse or read my blood pressure. I was admitted to the hospital, and they found that I had orthostatic hypotension. I was placed on a heart monitor.”

Orthostatic hypotension can interfere with daily life in significant ways and may even be dangerous. Understanding how it is connected to MS and how to manage it can help you keep an eye on this symptom and prevent more serious problems from developing.

Can MS Give You Low Blood Pressure When Standing Up?

Healthcare providers and researchers are still trying to learn about the connection between orthostatic hypotension and MS. Some think that MS could be a cause of lightheadedness and low blood pressure when standing, but research on the subject is currently mixed. Orthostatic hypotension has many other causes that are more common.

The Potential Connection Between MS and Low Blood Pressure

Orthostatic hypotension is one variety of autonomic nervous system dysfunction seen in people with MS. The autonomic nervous system controls automatic bodily functions like blood pressure, heart rate, and digestion. Other MS-related problems with the autonomic nervous system can include:

• Sleep problems
• Bladder issues
• Gastrointestinal problems
• Unwarranted sweating
• Cardiovascular issues

In MS, autoimmune attacks result in demyelination (damage to the nerves’ protective myelin coating). This damage causes symptoms like nerve and muscle problems.

Some researchers believe that autonomic abnormalities develop when certain brain regions are affected. When a person stands up, their blood vessels automatically constrict (tighten). This keeps blood pressure high enough to avoid dizziness, lightheadedness, syncope (fainting), and falls.

The impact of MS on cardiovascular autonomic dysfunction is not fully understood. One study found that people with MS make less norepinephrine, a chemical that is important for your fight-or-flight response, which constricts blood vessels and raises your blood pressure. Without enough norepinephrine, people with MS were shown to respond less appropriately to a stressful activity like exercise. Researchers are still looking into other ways MS and orthostatic hypotension are connected.

MS Treatments and Low Blood Pressure

Medications commonly come with side effects. Studies show that some MS treatments can cause low blood pressure when standing. For example, fingolimod (Gilenya) can interfere with your blood pressure level and heart rate. Around 4 percent of people in one study experienced orthostatic hypotension when taking ozanimod (Zeposia).

If you notice any new lightheadedness or dizziness with MS treatments, talk to your doctor. They can adjust the dosing or medication to prevent side effects.

Other Causes of Low Blood Pressure When Standing Up

Orthostatic hypotension can occur unrelated to MS. Age is one risk factor for this particular type of low blood pressure. It appears more commonly in adults aged 65 or older. Some medications — like diuretics, beta-blockers, and certain antidepressants — also put a person at risk for orthostatic hypotension. In some people, orthostatic hypotension occurs immediately after eating a large meal. That type of dizziness is known as postprandial hypotension.

Orthostatic hypotension is usually linked to:

• Parkinson’s disease
• Thyroid conditions
• Diabetes or hypoglycemia (low blood glucose)
• Heart disease (like heart failure or heart attack)
• Dementia (specifically, Lewy body dementia)
• Multiple system atrophy

Orthostatic hypotension can also be a sign that you’re badly dehydrated and your blood volume is low. Severe dehydration can occur after prolonged spells of sweating or vomiting.

How To Manage Low Blood Pressure When Standing Up

If you experience orthostatic hypotension for long periods of time or every time you stand up, you should talk to your neurologist (doctor specializing in the brain, spinal cord, and nerves). They can determine whether this symptom is related to MS and work with you to find the best way of managing it.

There are a number of ways to manage orthostatic hypotension associated with MS. You may need to work with both a neurologist and a cardiologist to determine the best approaches or treatments for you.

Diet and Lifestyle Changes

Some people with MS may be advised to see if lifestyle changes help them manage their orthostatic hypotension. While these will not eliminate the cause of the condition, they may help reduce how often it occurs.

Healthcare providers may recommend:

• Drinking more water
• Eating a diet higher in salt
• Avoiding alcohol
• Preventing overheating
• Uncrossing your legs when sitting
• Sleeping with your head elevated

All of these can help raise blood volume and ensure proper blood flow when you stand up.

“The cardiologist recommended that I drink at least 64 ounces of water per day and increase my salt intake,” wrote one MyMSTeam member. “I must say that a number of things have improved significantly, and my ‘plumbing’ is working better. I make sure I empty four 20-ounce water bottles per day.”

Another member echoed this, adding, “The cardiologist put me on a ‘high-salt, high-fluid’ diet to keep my blood pressure up. I live on Goldfish crackers, LOL! It has helped a lot, in addition to resting after I eat.”

Compression Garments

Orthostatic hypotension can worsen when blood builds up in the legs. Special compression stockings help prevent this from occurring and minimize orthostatic hypotension. These are tight socks that help your blood vessels constrict when you stand.

Similarly, medical abdominal binders cinch around the middle of the body and serve the same purpose as compression stockings.

Medication for Low Blood Pressure When Standing Up

There are a few medications that can be useful to people diagnosed with orthostatic hypotension. These drugs help raise your blood pressure to prevent dizziness. According to Mayo Clinic, examples include:

• Droxidopa (Northera)
• Fludrocortisone
• Midodrine (Orvaten)
• Pyridostigmine (Mestinon, Regonol)

These medications can come with side effects and may not combine well with some MS treatments. Your doctors will need to work together and coordinate your medications to make sure the combination is both safe and effective for you.

Treat Your MS

Avoiding MS relapses may improve symptoms. Treating MS with effective disease-modifying therapies (DMTs) might be the best long-term approach for preventing orthostatic hypotension. There are many treatment options available for MS. You and your neurology team will work together cooperatively in a process known as shared decision-making to decide on your best course of MS treatment.

Find Your Team

On MyMSTeam, the social support network for people with multiple sclerosis and their loved ones, more than 219,000 members come together to share tips and experiences, ask questions, and support each other. You can join and start building your team today.

Do you experience dizziness when you stand up? Have you talked to your doctor about orthostatic hypotension? Share your story in the comments below or by posting on your Activities page.