Hello, The primary issue to be seriously considered in your case is clinically excessive and persistent hypotension rather than just simple orthostatic hypotension. In such case, as you are experiencing a very obvious related symptomatology, it is important to avoid all the potential triggering factors of this persistent hypotension. First of all, a review of your actual therapy is necessary. All the three components of your treatment (Irbesartan, Coreg and Flomax) have important hypotensive effects and thus needs to be urgently stopped: Irbesartan and Flomax should be avoided at least for the moment, while Coreg be gradually reduced further up to a minimal daily dose (to avoid rebound phenomenon) or completely stooped at the end (a more rational strategy would be substituting Coreg with another more appropriate beta-blocker without vasodilating properties). In addition, as you have experienced two previous heart attacks and are suffering from COPD & diabetes, it is necessary to review your actual overall cardiac performance (left and right heart), as you are demonstrating signs and symptoms of peripheral hypo-perfusion. Heart failure should be carefully investigated. In this regard, several medical tests are necessary: - resting ECG, - cardiac ultrasound, - cardiac enzymes, - renal and liver function tests, - chest X-ray study, - complete blood count, - fasting blood glucose level, - blood electrolytes level Another component that may influence on low blood pressure is potential blood glucose level imbalance due to not properly controlled diabetes. High blood glucose levels may lead to increased glucose in urine and increased urine output. This is followed with decreased plasma volume and subsequent hypotension. That s why it is important to properly control your diabetes. Regarding partial jerks, it is advisable to consult with a neurologist as they are signs of neuropathy in the settings of diabetes. You need to discuss with your attending doctor no the above-mentioned issues. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Ivan R. Rommstein, General Surgeon