Orthostatic Hypotension in Older Patients

Abstract

Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20 mmHg or of diastolic blood pressure of at least 10 mmHg within 3 min of standing. It occurs in 30–50% of elderly individuals with disease and/or medication risk factors. It is uncommon in healthy elderly people. Most patients with orthostatic blood pressure changes do not have typical symptoms and therefore symptoms are not helpful in deciding who should be screened. Epidemiological data suggest that the presence of orthostatic hypotension is associated with syncope, falls, stroke and death. The treatment approach is not standardized, but a stepped-care algorithm is presented in this article, which is likely to be successful in many patients. Future studies need to focus on the potential benefits of screening and treating patients with this disorder, especially if they are asymptomatic.