Identification and management of orthostatic hypotension in older and medically complex patients

Abstract

Orthostatic hypotension is defined as a drop in systolic blood pressure (BP) of at least 20 mmHg or of diastolic BP of at least 10 mmHg within 3 min of standing. It is uncommon in the healthy elderly. However, it occurs in 30–50% of elderly persons with known risk factors and is another example of a multifactorial geriatric syndrome similar to falls and delirium. Most patients with orthostatic hypotension either have no symptoms or atypical symptoms, and therefore, screening BPs should be taken in all patients with risk factors. The treatment approach is not standardized but a stepped-care algorithm is presented that is likely to be successful for many patients. Future studies need to focus on the potential benefits of screening and treating patients with this disorder.

Keywords::

• α-adrenergic agonist
• aging
• fludrocortisone
• hypotension
• midodrine
• mineralocorticoid
• orthostatic hypotension
• sodium chloride

Financial & competing interests disclosure

SL Mader does research in orthostatic hypotension that is funded by the US Department of Veterans Affairs. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

COPD: Chronic obstructive pulmonary disease.

b.i.d.: Twice a day; BP: Blood pressure; KCl: Potassium chloride; NaCl: Sodium chloride; q.d.: Once daily; t.i.d.: Three-times a day.