Orthostatic hypertension is a condition in which going from a supine to a standing posture triggers an inappropriate rise in blood pressure. This can sometimes be detected by a bedside examination, but since the hypertensive response can also be delayed, tilt table testing is more sensitive. There is no universally accepted definition, but most clinicians use an increase of 20 mm Hg in systolic blood pressure as a criterion. Orthostatic hypertension can occur at any age; literature often describes it as having a greater prevalence in older age, and it has also been reported in association with renal disease, diabetes mellitus, and dysautonomia. The underlying mechanism of disease is not known, though proposed mechanisms include primary autonomic dysfunction and vascular causes. Orthostatic hypertension can manifest with lightheadedness upon standing, curiously resembling the “opposite” condition of orthostatic hypotension. Given the association of orthostatic hypertension with cardiovascular and renal disease, these patients should be referred to cardiology and/or nephrology.