Abstract
Our review presents orthostatic hypotension (OH), which is defined as a reduction of systolic blood pressure of 320 mm Hg and/or diastolic blood pressure of 310 mm Hg within 3 minutes of standing after being supine. OH is common in elderly people and is associated with syncope, falls, fractures, and increased morbidity, leading to functional impairment and hospitalization. The prevalence of OH is age dependent, ranging from 5% in patients <50 years of age, in individuals over 70 years of age more than 20% can be affected. Postural change in blood pressure (BP) is associated with cardiovascular disease events and is now recognized as an independent risk factor for cardiovascular morbidity and mortality. Epidemiological studies have reported associations of OH with coronary artery disease, stroke, and heart failure. The presence of OH doubles the risk of developing chronic kidney disease. Most patients with orthostatic hypotension either have no symptoms or nonspecific symptoms, and therefore, screening BP should be taken in all patients with risk factors. Despite being largely asymptomatic or with minimal symptoms, the presence of OH independently increases mortality and the incidence of myocardial infarction, stroke, heart failure, and atrial fibrillation. It substantially reduces quality of life. In normal subjects, because of an autoregulatory mechanism, the BP shows minimal variation with posture-dependent changes. In most hypertensive patients without autonomic nervous dysfunction, the postural BP changes are also minimal. Failure of these compensatory mechanisms results in OH. Evaluation of suspected OH begins by identifying reversible causes and underlying associated medical conditions.
We outline the prevalence and etiology of OH in the general population, its relationship with morbidity and mortality, propose a diagnostic and therapeutic algorithm, and delineate current challenges and future perspectives.