Orthostatic hypotension

Article (PDF Available)inClinics in Geriatric Medicine 18(2):253-68 · June 2002with80 Reads
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.
    • "Standing Hypotension (SH) is a major drop-down in Blood Pressure (BP). Severe SH, referred as Orthostatic Hypotension (OH) [1], is defined as drop down (-20 mmHg) in systolic BP due to standing, has an incidence of 4% to 33% in elderly, and causes lightheadedness, cognitive impairment, blurred vision and vertigo. These symptoms, associated with exposure to extrinsic (environmental dependent) risk factors, causes up to the 30% of falls in later life, and consequently fractures and other major impairments [2]. "
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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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