Current concepts in orthostatic hypotension management

Amy C. Arnold, Cyndya Shibao

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Orthostatic hypotension is a condition commonly affecting the elderly and is often accompanied by disabling presyncopal symptoms, syncope and impaired quality of life. The pathophysiology of orthostatic hypotension is linked to abnormal blood pressure regulatory mechanisms and autonomic insufficiency. As part of its diagnostic evaluation, a comprehensive history and medical examination focused on detecting symptoms and physical findings of autonomic neuropathy should be performed. In individuals with substantial falls in blood pressure upon standing, autonomic function tests are recommended to detect impairment of autonomic reflexes. Treatment should always follow a stepwise approach with initial use of nonpharmacologic interventions including avoidance of hypotensive medications, high-salt diet and physical counter maneuvers. If these measures are not sufficient, medications such as fludrocortisone and midodrine can be added. The goals of treatment are to improve symptoms and to make the patient as ambulatory as possible instead of targeting arbitrary blood pressure values.

Original languageEnglish (US)
Pages (from-to)304-312
Number of pages9
JournalCurrent Hypertension Reports
Volume15
Issue number4
DOIs
StatePublished - Aug 2013

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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