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Hypotension, Orthostatic

A. Miles Scott, DO and Matthew B. Nodelman, M.D. Reviewed 05/2023
 


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; to reduce complications such as falls, cardiovascular disease, and cognitive impairment; and not to target a par...

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

1
Biaggioni I. Orthostatic hypotension in the hypertensive patient. Am J Hypertens. 2018;31(12):1255–1259.
2
Freeman R, Abuzinadah AR, Gibbons C, et al. Orthostatic hypotension: JACC state-of-...

ADDITIONAL READING

  • Joseph A, Wanono R, Flamant M, et al. Orthostatic hypotension: a review.  Nephrol Ther. 2017;13Suppl1:S55–S67.

  • Kamaruzzaman S, Watt H, Carso...

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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