Postural hypotension in the elderly

Abstract

Postural or orthostatic hypotension is a very common phenomenon in geriatric clinical practice. If severe, it is very disabling, since at best it leads to a self-perpetuating loss of confidence, and at worst to the patient taking to bed and staying there. It is a common cause of falls, particularly on the way from bed to toilet at night or on rising in the morning. In any elderly patient with a complaint of dizziness or falls, the blood pressure must be taken both lying and standing. If orthostatic hypotension seems likely from the history, it is wise to take the blood pressure with the patient sitting before standing, as this may avoid the embarrassment of having to pick the patient up from the floor (Caird and Judge, 1974). In some patients the pressure falls progressively on walking, and if the history suggests this possibility, then it should be taken both immediately after standing and after walking 5-10 m. If these elementary clinical observations are made, ‘vertebrobasilar insufficiency’ will be very rarely diagnosed in the elderly. Indeed, the heretical speculation that this diagnosis has no real existence in old age is more than tempting.