Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 15; no. 3; p. e010573
• Main Authors: Fedorowski, Artur, Ricci, Fabrizio, Hamrefors, Viktor, Sandau, Kristin E., Hwan Chung, Tae, Muldowney, James A.S., Gopinathannair, Rakesh, Olshansky, Brian
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.03.2022
• Subjects: Cardiology and Cardiovascular Disease; Cardiovascular Diseases - complications; Clinical Medicine; Cognitive Dysfunction - complications; Humans; Hypertension - complications; Hypotension, Orthostatic - diagnosis; Hypotension, Orthostatic - etiology; Hypotension, Orthostatic - therapy; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Syncope; heart failure; orthostatic hypotension; cardiovascular diseases; patient care; hypertension
• ISSN: 1941-3084; 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.121.010573

Orthostatic hypotension (OH), a common, often overlooked, disorder with many causes, is associated with debilitating symptoms, falls, syncope, cognitive impairment, and risk of death. Chronic OH, a cardinal sign of autonomic dysfunction, increases with advancing age and is commonly associated with neurodegenerative and autoimmune diseases, diabetes, hypertension, heart failure, and kidney failure. Management typically involves a multidisciplinary, patient-centered, approach to arrive at an appropriate underlying diagnosis that is causing OH, treating accompanying conditions, and providing individually tailored pharmacological and nonpharmacological treatment. We propose a novel streamlined pathophysiological classification of OH; review the relationship between the cardiovascular disease continuum and OH; discuss OH-mediated end-organ damage; provide diagnostic and therapeutic algorithms to guide clinical decision making and patient care; identify current gaps in knowledge and try to define future research directions. Using a case-based learning approach, specific clinical scenarios are presented highlighting various presentations of OH to provide a practical guide to evaluate and manage patients who have OH.