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Cited by 388Cardiovascular Syncope and Autonomic DisordersBalance, Gait, and Falls PreventionHeart Rate Variability and Autonomic Control

The DOI matches its Crossref record; 11 of the 12 references it cites were found in a registry or an index.

Orthostatic Hypotension in the Elderly: Diagnosis and Treatment

Gupta, Vishal, Lipsitz, Lewis A.·2007·The American Journal of Medicine
DOI 10.1016/j.amjmed.2007.02.023
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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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Crossref · 10.1016/j.amjmed.2007.02.023

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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)
DOI
10.1016/j.amjmed.2007.02.023
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
Licence
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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