Current Hypertension Reports

, Volume 15, Issue 4, pp 304–312

Current Concepts in Orthostatic Hypotension Management

Hypertension and the Heart (PW de Leeuw and AH Gradman, Section Editors)

DOI: 10.1007/s11906-013-0362-3

Cite this article as:
Arnold, A.C. & Shibao, C. Curr Hypertens Rep (2013) 15: 304. doi:10.1007/s11906-013-0362-3


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.


Orthostatic hypotension Elderly Midodrine Fludrocortisone Autonomic insufficiency Autonomic failure Neurogenic orthostatic hypotension Hypertension 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Clinical Pharmacology, Department of MedicineVanderbilt University School of MedicineNashvilleUSA

Personalised recommendations