Orthostatic hypotension

Harvard University, Cambridge, Massachusetts, United States
Clinics in Geriatric Medicine (Impact Factor: 1.83). 06/2002; 18(2):253-68. DOI: 10.1016/S0749-0690(02)00008-3
Source: PubMed


A common problem among elderly people, orthostatic hypotension is associated with significant morbidity and mortality, which may be caused by medications, the cumulative effects of age- and hypertension-related alterations in blood pressure regulation, or age-associated diseases that impair autonomic function. Evaluation requires multiple blood pressure measurements taken at different times of the 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 hypotension 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 caused by 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, and fractures, and an attenuation of functional decline in elderly patients.

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Available from: Lewis A Lipsitz, Oct 04, 2015
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    • "Hypotension, including orthostatic hypotension, is associated with significant morbidity and mortality (Mukai and Lipsitz 2002). Furthermore, it has been identified as serious risk factor for stroke and coronary artery disease in the elderly (Eigenbrodt et al. 2000; Jones et al. 2012; Masaki et al. 1998; Rose et al. 2006). "
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    Phytomedicine 09/2014; 21(11):1349–1355. DOI:10.1016/j.phymed.2014.06.014 · 3.13 Impact Factor
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    • "Subjects were asked to inspire a gas mixture of 8% CO2, 21% O2, and balance nitrogen for 2 minutes and then mildly hyperventilate to an end-tidal CO2 of approximately 25 mmHg for 2 minutes. Postural blood pressure (BP) measurements were obtained according to a standardized measurement technique [80]. In a substudy of subjects with slow gait speed and controls, cerebral blood flow changes in response to cognitive activation were measured during a separate visit, as reported elsewhere [81]. "
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