Orthostatic hypotension is a drop in blood pressure that occurs when moving from a lying down (supine) position to a standing (upright) position. It is a common problem among elderly patients, associated with significant morbidity and mortality. Orthostatic hypotension is associated with a higher risk of falls, fractures, dementia, and death, so prompt recognition and treatment are essential.
There are two forms of orthostatic hypotension that result from two main causes. Neurogenic orthostatic hypotension often occurs along with nervous system disorders such as Parkinsons disease, dementia with Lewy bodies, multiple system atrophy, pure autonomic failure, diabetes, Guillain-Barré syndrome, dopamine beta-hydroxylase deficiency, or infections that cause disturbances in nerve function (neuropathy) . The non-neurogenic form of orthostatic hypotension is usually caused by something obvious, such as dehydration or lengthy bed rest.
While acute orthostatic hypotension is usually secondary to medication, fluid or blood loss, or adrenal insufficiency, chronic orthostatic hypotension is frequently due to altered blood pressure regulatory mechanisms and autonomic dysfunction. The diagnostic evaluation requires a comprehensive history including symptoms of autonomic nervous system dysfunction, careful blood pressure measurement at various times of the day and after meals or medications, and laboratory studies.
With proper evaluation and management, the occurrence of adverse events, including falls, fracture, functional decline, and myocardial ischemia, can be significantly reduced.
