Orthostatic hypotension

Orthostatic hypotension is a common problem among elderly people which is associated with significant morbidity and mortality It may be due to the cumulative effects of age- and hypertension-related alterations in blood pressure regulation, to medications, or to age-associated diseases that impair autonomic function. The evaluation requires multiple blood pressure measures at different times of day and after meals or medications. Central and peripheral nervous system disorders should be sought, and the laboratory evaluation should concentrate on ruling out diabetes mellitus, amyloidosis, occult malignancy, and vitamin deficiencies. If orthostatic hypertension is detected, it should be considered a risk factor for adverse outcomes and treated first with nonpharmacologic interventions, including the withdrawal of potentially hypotensive medications. In patients with hypertension and orthostatic hypotension, the judicious treatment of hypertension may be helpful. For persistent, symptomatic orthostatic hypotension due to autonomic failure, pharmacologic interventions include fludrocortisone, midodrine, and a variety of other agents. The careful evaluation and management of orthostatic hypotension will hopefully result in a significant reduction in falls, syncope, fractures, and functional decline in elderly patients.