EFNS guidelines on the diagnosis and management of orthostatic hypotension
Open accessAbstract
Orthostatic (postural) hypotension (OH) is a common, yet under diagnosed disorder. It may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in primary and secondary autonomic disorders. These range from visual disturbances and dizziness to loss of consciousness (syncope) after postural change. Evidence based guidelines for the diagnostic workup and the therapeutic management (non‐pharmacological and pharmacological) are provided based on the EFNS guidance regulations. The final literature research was performed in March 2005. For diagnosis of OH, a structured history taking and measurement of blood pressure (BP) and heart rate in supine and upright position are necessary. OH is defined as fall in systolic BP below 20 mmHg and diastolic BP below 10 mmHg of baseline within 3 min in upright position. Passive head‐up tilt testing is recommended if the active standing test is negative, especially if the history is suggestive of OH, or in patients with motor impairment. The management initially consists of education, advice and training on various factors that influence blood pressure. Increased water and salt ingestion effectively improves OH. Physical measures include leg crossing, squatting, elastic abdominal binders and stockings, and careful exercise. Fludrocortisone is a valuable starter drug. Second line drugs include sympathomimetics, such as midodrine, ephedrine, or dihydroxyphenylserine. Supine hypertension has to be considered.
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- Authors
- Lahrmann, H., Cortelli, P., Hilz, M., Mathias, C. J., Struhal, W., & Tassinari, M.
- Affiliations
- Kaiser-Franz-Josef-Spital (AT)
- University of Bologna (IT)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- St Mary's Hospital (GB)
- Corresponding author
- Lahrmann, H.
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2006-08-23
- Volume
- 13
- Issue
- 9
- Pages
- 930-936
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W1983067632
- Cited by
- 334
- References
- 56
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 13 · 2023: 19 · 2022: 22 · 2021: 19 · 2020: 13 · 2019: 26 · 2018: 18 · 2017: 23 · 2016: 23 · 2015: 11 · 2014: 23 · 2013: 19 · 2012: 21
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- orthostatic hypotension, autonomic dysfunction, syncope, head-up tilt, blood pressure measurement, fludrocortisone, midodrine, sympathomimetic drugs, non-pharmacological treatment, supine hypertension
- MeSH terms
- Diagnosis, Differential, Humans, Hypotension, Orthostatic, Practice Guidelines as Topic
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