Hypotension, Orthostatic

Victoria Shepard, MD Reviewed 06/2021

BASICS

Orthostatic hypotension (OH) is a failure of cardiovascular reflexes to maintain adequate blood pressure (BP) on assuming an upright position. The presence of OH is an independent risk factor ...

DIAGNOSIS

Initial approach: detailed history and physical examination with a focus on neurodegenerative disorders and neuropathy; thorough medication review; screening for reversible causes: 12-lead E...

TREATMENT

The treatment goal of OH should be to improve symptoms and functional status and not to target a particular blood pressure.
Treatment should proceed in a stepwise fashion with non-pharmacolog...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Monitor for significant supine HTN, fluid overload, electrolyte abnormalities, and HF in patients under medical treatment. In patients without an apparent cause o...

REFERENCES

Biaggioni I. Orthostatic hypotension in the hypertensive patient. Am J Hypertens. 2018;31(12):1255-1259.

Freeman R, Abuzinadah AR, Gibbons C, J, et al. Orthostatic hypotension: JACC state-...

ADDITIONAL READING

Joseph A, Wanono R, Flamant M, et al. Orthostatic hypotension: a review. Nephrol Ther. 2017;13Suppl1:S55-S67.
Kamaruzzaman S, Watt H, Carson...

CODES

ICD10

I95.1 Orthostatic hypotension

SNOMED

28651003 Orthostatic hypotension (disorder)
371073003 postural orthostatic tachycardia syndrome (disorder)

CLINICAL PEARLS

OH is multifactorial and ranges from asymptomatic to debilitating. Regardless of symptoms, the presence of OH is an independent risk factor for mortality and falls. Treatment should be...

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