Identification and Management of Orthostatic Hypotension in Older and Medically Complex Patients

Scott L Mader


Expert Rev Cardiovasc Ther. 2012;10(3):387-395. 

In This Article

Abstract and Introduction


Orthostatic hypotension is defined as a drop in systolic blood pressure (BP) of at least 20 mmHg or of diastolic BP of at least 10 mmHg within 3 min of standing. It is uncommon in the healthy elderly. However, it occurs in 30–50% of elderly persons with known risk factors and is another example of a multifactorial geriatric syndrome similar to falls and delirium. Most patients with orthostatic hypotension either have no symptoms or atypical symptoms, and therefore, screening BPs should be taken in all patients with risk factors. The treatment approach is not standardized but a stepped-care algorithm is presented that is likely to be successful for many patients. Future studies need to focus on the potential benefits of screening and treating patients with this disorder.


Orthostatic (also referred to as postural) hypotension (OH) is a common clinical problem in elderly persons seen in a medical practice. It is sometimes associated with typical symptoms, such as dizziness or presyncope, but more often may present with either atypical symptoms, such as neck pain, or may be completely asymptomatic. The condition of OH in older patients is another example of a multifactorial geriatric syndrome similar to delirium and falls. Identification and treatment may improve patient independence and function. OH occurs in 30–50% of elderly persons with disease and/or medication risk factors, but is uncommon in the healthy elderly. Clinical and epidemiological studies show that OH is associated with falls, syncope and hospitalization; they also demonstrate that OH is an independent risk factor for cardiovascular disease, kidney disease and death. This paper will review several aspects of this important disorder in older and medically complex patients, as well as suggest a stepped-care treatment algorithm.