To the Editor: Orthostatic hypotension is an important condition to diagnose and manage in elderly adults. This letter provides a concise, evidence-based update on five things a clinician should know about orthostatic hypotension and aging. A large prospective study identified the presence of OH as an independent risk factor for recurrent falls in elderly adults (aged ≥60) who had experienced falls in the last 6 months (relative risk = 2.6; 95% confidence interval = 1.7–4.6).1 Because falls in elderly adults can result in hip fracture, head trauma, and functional decline, clinicians should screen for and manage OH in these high-risk individuals. There is also recent evidence that OH may contribute to cognitive decline that can occur with aging.2 The Consensus Committee of the American Autonomic Society and the American Academy of Neurology have defined OH as a sustained reduction of systolic blood pressure (SBP) of 20 mmHg or of diastolic blood pressure (DBP) of 10 mmHg or more within 3 minutes of standing.3 However, the most-recent 2011 consensus statement update includes definitions for other variants of OH, including initial and delayed OH. Initial OH was defined as a transient blood pressure decrease (≥40 mmHg SBP or ≥20 mmHg DBP) within 15 seconds of standing, and delayed OH was defined as OH that occurs more than 3 minutes after a postural challenge.4 These types of OH need to be considered when screening high-risk individuals, especially because delayed OH may be more difficult to detect in the setting of clinical time restrictions. An observational study of 342 individuals aged 75 and older found the prevalence of OH in those receiving zero, one, two, or three or more potentially causative medications was 35%, 58%, 60%, and 65%, respectively.5 High-risk medications were identified as antihypertensives, diuretics, antidepressants, and alpha-blocker prostate medications.5 Diseases affecting the central (e.g., Parkinson's disease) and peripheral (e.g., diabetes mellitus) nervous systems are more prevalent and increase the risk of OH in elderly adults. OH associated with type 1 and type 2 diabetes mellitus is primarily due to peripheral neuropathy with damage of the small diameter fibers, for which poor glycemic control is an established risk factor.6 OH was present in 18.2% of individuals aged 65 and older in a large observational study, of whom 87% were asymptomatic.7 Even with profound OH (drop in systolic blood pressure ≥60 mmHg), up to 43% had typical symptoms (e.g., dizziness, visual symptoms, shoulder “coat-hanger” pain), whereas 33% had no symptoms at all, and 24% had atypical symptoms including backache and lower extremity discomfort.8 Start by correcting reversible causes (e.g., anemia, hypovolemia), initiating nonpharmacological measures, and removing or reducing high-risk medications when possible; if these measures fail, pharmacological management of OH should be considered (Table 1). The goal of treatment is to improve the individual's functional capacity and quality of life and to prevent injury, rather than to achieve a target blood pressure.9 Target water intake to 2–2.5 L/d.10 When symptomatic, rapidly drinking 500 mL of water can quickly expand plasma volume.10 Midodrine 2.5–10 mg orally up to three times per day.10 Short-acting alpha adrenomimetic (up to 4 hours); acts through direct blood vessel constriction. Conflict of Interest: The authors have no conflict of interest with the contents of this manuscript. Dr. P. Mills received research salary funding from the Vancouver Coastal Health Research Institute, TD Grants in Medical Excellence, and VGH & UBC Hospital Foundation during the writing of this manuscript. Author Contributions: All authors contributed equally to the conception and writing of this manuscript. Sponsor's Role: None.