Hypotension.
What is hypotension?
Hypotension is the medical term for abnormally low blood pressure — generally defined as systolic pressure below 90 mmHg or diastolic pressure below 60 mmHg, though symptoms can occur at higher levels in people whose normal blood pressure is elevated. Low blood pressure reduces blood flow to the brain and other vital organs, producing the characteristic symptoms of dizziness, lightheadedness, blurred vision, fatigue and occasionally fainting (syncope).
For many people, a naturally low blood pressure is a sign of cardiovascular fitness rather than a problem — athletes and young adults often have resting blood pressures well below the standard threshold without symptoms. Hypotension becomes clinically significant when it produces symptoms that affect quality of life, function or safety.
Types of hypotension
Understanding the type of hypotension is important because each has different causes, triggers and management approaches.
Orthostatic (postural) hypotension is the most common type seen in physiotherapy and exercise physiology practice. It occurs when blood pressure drops significantly upon standing from a lying or seated position — typically defined as a drop of 20 mmHg or more in systolic pressure within three minutes of standing. The resulting dizziness and near-fainting is a significant safety risk, particularly in older adults where it is one of the leading contributors to falls. It is also a cardinal feature of POTS (postural orthostatic tachycardia syndrome), where the autonomic nervous system's failure to adequately compensate for positional change produces a characteristic increase in heart rate alongside the blood pressure drop.
What causes hypotension?
The causes are diverse — dehydration, prolonged bed rest, heat exposure, blood loss, pregnancy, cardiac conditions, autonomic neuropathy (a complication of diabetes), and systemic conditions including Ehlers-Danlos syndrome and other connective tissue disorders. In hypermobility spectrum disorders, autonomic dysfunction including orthostatic hypotension and POTS is a recognised associated feature, thought to relate to abnormal vascular tone and reduced venous return from hypermobile vessels.
How can physiotherapy and exercise physiology help?
Physiotherapy and exercise physiology play a meaningful role in managing hypotension, particularly orthostatic and POTS-related hypotension, through structured exercise programs that improve cardiovascular function, venous return and autonomic regulation.
The exercise approach to orthostatic and POTS-related hypotension follows evidence-based graduated protocols — beginning with recumbent or semi-reclined exercises that avoid the orthostatic challenge of upright activity, and very gradually progressing toward more upright positions as cardiovascular adaptation improves. Strengthening exercises promote better blood flow and muscle activity to counteract the effects of low blood pressure, while cardiovascular conditioning at low intensity helps improve cardiovascular function.
Postural training educates patients on gradual position changes, particularly from lying to standing. The large leg and core muscles act as a venous pump — building their strength and activation significantly improves venous return to the heart and reduces the blood pooling that drives orthostatic symptoms.
Pacing is critical — attempting to progress exercise too quickly in the context of dysautonomia and hypotension typically worsens symptoms and undermines the adaptation process. Learning to recognise symptom patterns and work within the current cardiovascular envelope is a skill we actively develop with patients.
Non-exercise interventions that physiotherapy and exercise physiology can guide include hydration and salt loading strategies, compression garment use to reduce venous pooling, and positional strategies for daily activities that minimise orthostatic stress.
For patients with hypotension in the context of POTS, Ehlers-Danlos syndrome or other systemic conditions, we integrate management of the hypotension into the broader treatment plan rather than treating it in isolation. Balance and gait training to improve stability and prevent falls, which hypotensive patients are at particular risk for, is also an important component — particularly for older adults where fall consequences are most serious. Our Balance and Bones exercise classes are well suited to this population.
The Australian POTS Foundation provides excellent resources for patients with POTS-related hypotension and dysautonomia. Medical management of the underlying cause — coordinated with the patient's GP or specialist — is complementary to physiotherapy and exercise physiology for most presentations of symptomatic hypotension.
Our physiotherapist Yulia Khasyanova and Exercise Physiologist Ash O'Regan both have experience in dysautonomia and hypotension management, particularly in patients with POTS, Ehlers-Danlos syndrome and related connective tissue disorders.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Hypotension is the medical term for abnormally low blood pressure — generally defined as systolic pressure below 90 mmHg or diastolic pressure below 60 mmHg, though symptoms can occur at higher levels in people whose normal blood pressure is elevated. Low blood pressure reduces blood flow to the brain and other vital organs, producing the characteristic symptoms of dizziness, lightheadedness, blurred vision, fatigue and occasionally fainting (syncope).
For many people, a naturally low blood pressure is a sign of cardiovascular fitness rather than a problem — athletes and young adults often have resting blood pressures well below the standard threshold without symptoms. Hypotension becomes clinically significant when it produces symptoms that affect quality of life, function or safety.
Types of hypotension
Understanding the type of hypotension is important because each has different causes, triggers and management approaches.
Orthostatic (postural) hypotension is the most common type seen in physiotherapy and exercise physiology practice. It occurs when blood pressure drops significantly upon standing from a lying or seated position — typically defined as a drop of 20 mmHg or more in systolic pressure within three minutes of standing. The resulting dizziness and near-fainting is a significant safety risk, particularly in older adults where it is one of the leading contributors to falls. It is also a cardinal feature of POTS (postural orthostatic tachycardia syndrome), where the autonomic nervous system's failure to adequately compensate for positional change produces a characteristic increase in heart rate alongside the blood pressure drop.
- Neurally mediated hypotension (also called vasovagal syncope or neurocardiogenic syncope) occurs when the nervous system sends incorrect signals that cause both heart rate and blood pressure to drop simultaneously, typically triggered by prolonged standing, heat, pain or emotional stress. It is the most common cause of fainting in otherwise healthy young people.
- Post-prandial hypotension — a drop in blood pressure after eating — is common in older adults and in people with autonomic dysfunction, occurring as blood is redirected to the digestive system.
- Medication-induced hypotension is common in people taking antihypertensives, diuretics, beta-blockers or various cardiac medications, particularly when doses are changed or when fluid intake is reduced.
What causes hypotension?
The causes are diverse — dehydration, prolonged bed rest, heat exposure, blood loss, pregnancy, cardiac conditions, autonomic neuropathy (a complication of diabetes), and systemic conditions including Ehlers-Danlos syndrome and other connective tissue disorders. In hypermobility spectrum disorders, autonomic dysfunction including orthostatic hypotension and POTS is a recognised associated feature, thought to relate to abnormal vascular tone and reduced venous return from hypermobile vessels.
How can physiotherapy and exercise physiology help?
Physiotherapy and exercise physiology play a meaningful role in managing hypotension, particularly orthostatic and POTS-related hypotension, through structured exercise programs that improve cardiovascular function, venous return and autonomic regulation.
The exercise approach to orthostatic and POTS-related hypotension follows evidence-based graduated protocols — beginning with recumbent or semi-reclined exercises that avoid the orthostatic challenge of upright activity, and very gradually progressing toward more upright positions as cardiovascular adaptation improves. Strengthening exercises promote better blood flow and muscle activity to counteract the effects of low blood pressure, while cardiovascular conditioning at low intensity helps improve cardiovascular function.
Postural training educates patients on gradual position changes, particularly from lying to standing. The large leg and core muscles act as a venous pump — building their strength and activation significantly improves venous return to the heart and reduces the blood pooling that drives orthostatic symptoms.
Pacing is critical — attempting to progress exercise too quickly in the context of dysautonomia and hypotension typically worsens symptoms and undermines the adaptation process. Learning to recognise symptom patterns and work within the current cardiovascular envelope is a skill we actively develop with patients.
Non-exercise interventions that physiotherapy and exercise physiology can guide include hydration and salt loading strategies, compression garment use to reduce venous pooling, and positional strategies for daily activities that minimise orthostatic stress.
For patients with hypotension in the context of POTS, Ehlers-Danlos syndrome or other systemic conditions, we integrate management of the hypotension into the broader treatment plan rather than treating it in isolation. Balance and gait training to improve stability and prevent falls, which hypotensive patients are at particular risk for, is also an important component — particularly for older adults where fall consequences are most serious. Our Balance and Bones exercise classes are well suited to this population.
The Australian POTS Foundation provides excellent resources for patients with POTS-related hypotension and dysautonomia. Medical management of the underlying cause — coordinated with the patient's GP or specialist — is complementary to physiotherapy and exercise physiology for most presentations of symptomatic hypotension.
Our physiotherapist Yulia Khasyanova and Exercise Physiologist Ash O'Regan both have experience in dysautonomia and hypotension management, particularly in patients with POTS, Ehlers-Danlos syndrome and related connective tissue disorders.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
