Orthostatic Hypotension—An Approach to Work Up and Management

Orthostatic hypotension (OH) is associated with undesirable impacts on patient quality of life, falls risk and mortality. OH can result from reversible causes such as hypovolaemia. It is more common amongst patients with hypertension and those with uncontrolled hypertension are at higher risk of poorer outcomes. Autonomic neuropathy, which can be secondary to comorbidities including diabetes mellitus and Parkinson's disease, can also lead to treatment refractory OH. Non-pharmacological approaches to management include use of compression garments and rising gradually. A thorough medication review is advocated, with a view to switching to alternative medications that are less likely to exacerbate OH. Midodrine, an alpha-1 adrenergic agonist is licensed for pharmacological management of OH in the UK. Referral to hypertension specialists is recommended by The National Institute for Health and Care Excellence (NICE) if treatment refractory.