Overview of orthostatic hypotension

The primary symptom of orthostatic hypotension is presyncope or syncope occurring on or soon after standing. Orthostatic hypotension is commonly defined as a fall in either systolic blood pressure (BP) of at least 20 mmHg or diastolic BP of at least 10 mmHg that occurs within 3 minutes of standing—see Diagnosis of orthostatic hypotension.

Thorough assessment is needed to investigate the cause and guide management of orthostatic hypotension. In general, orthostatic hypotension is caused by varying degrees of autonomic dysfunction, ranging from age-related autonomic impairment (compounded by other factors) to overt autonomic failure. Orthostatic hypotension commonly affects multimorbid elderly patients with polypharmacy, highlighting the often multifactorial nature of orthostatic hypotension. The causes and differential diagnoses of orthostatic hypotension can differ in young adults and the elderly.

Patients with orthostatic hypotension may present to the emergency department with syncope or related injuries; however, if the orthostatic hypotension is unrelated to an acute or life-threatening cause, it can be managed by a general practitioner. The mainstay of treatment for orthostatic hypotension is nondrug management; drug therapy may be needed if symptomatic orthostatic hypotension persists despite nondrug measures.