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Orthostatic Hypotension in the Elderly: Diagnosis and Treatment
Abstract
Orthostatic hypotension is a common problem among elderly patients, associated with significant morbidity and mortality. While acute orthostatic hypotension is usually secondary to medication, fluid or blood loss, or adrenal insufficiency, chronic orthostatic hypotension is frequently due to altered blood pressure regulatory mechanisms and autonomic dysfunction. The diagnostic evaluation requires a comprehensive history including symptoms of autonomic nervous system dysfunction, careful blood pressure measurement at various times of the day and after meals or medications, and laboratory studies. Laboratory investigation and imaging studies should be based upon the initial findings with emphasis on excluding diagnoses of neurodegenerative diseases, amyloidosis, diabetes, anemia, and vitamin deficiency as the cause. Whereas asymptomatic patients usually need no treatment, those with symptoms often benefit from a stepped approach with initial nonpharmacological interventions, including avoidance of potentially hypotensive medications and use of physical counter maneuvers. If these measures prove inadequate and the patient remains persistently symptomatic, various pharmacotherapeutic agents can be added, including fludrocortisone, midodrine, and nonsteroidal anti-inflammatory drugs. The goals of treatment are to improve symptoms and to make the patient as ambulatory as possible rather then trying to achieve arbitrary blood pressure goals. With proper evaluation and management, the occurrence of adverse events, including falls, fracture, functional decline, and myocardial ischemia, can be significantly reduced.
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“Preliminary evidence suggests that nocturnal HBPM can be used as an alternative to ABPM in the investigation of nocturnal BP in patients with sleep apnoea [230,231].”
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Metadata
- Authors
- Gupta, V., & Lipsitz, L. A.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Lipsitz, Lewis A.
- ORCID
- Lipsitz, Lewis A.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2007-10
- Volume
- 120
- Issue
- 10
- Pages
- 841-847
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2022065142
- Cited by
- 388
- References
- 12
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 29 · 2023: 25 · 2022: 21 · 2021: 20 · 2020: 26 · 2019: 29 · 2018: 27 · 2017: 32 · 2016: 22 · 2015: 18 · 2014: 26 · 2013: 20 · 2012: 23
- FWCI
- 11.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- orthostatic hypotension, older adults, autonomic dysfunction, blood pressure regulation, fludrocortisone, midodrine, nonsteroidal anti-inflammatory drugs, non-pharmacological treatment, falls, ambulatory function, differential diagnosis
- MeSH terms
- Adrenergic alpha-Agonists, Aged, Aged, 80 and over, Aging, Central Nervous System Stimulants, Anti-Inflammatory Agents, Blood Pressure Determination, Caffeine, Dose-Response Relationship, Drug, Erythropoietin, Fludrocortisone, Geriatrics, Humans, Hypotension, Orthostatic, Midodrine, Posture, Prostaglandin Antagonists, United States, Prevalence, Risk Reduction Behavior
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