Orthostatic blood pressure disorders in older adults: clinical phenotypes, diagnostic challenges, and cognitive and functional implications

Orthostatic blood pressure disorders are common in older adults and represent an important cardiovascular and hemodynamic challenge associated with falls, cognitive impairment, and loss of independence. This Perspective highlights the clinical spectrum of orthostatic blood pressure disorders in older adults, emphasizing the interplay between age-related cardiovascular and autonomic changes, diagnostic challenges, and their implications for cerebral perfusion, cognition, and functional status. Orthostatic hypotension, supine hypertension, orthostatic hypertension, and postprandial hypotension frequently coexist and fluctuate over time, reflecting impaired physiological reserve rather than isolated hemodynamic abnormalities. Because even modest posture-related blood pressure changes may have important clinical consequences, careful orthostatic assessment, including standardized supine-to-standing measurements and interpretation of heart rate responses, is essential for recognizing overlapping phenotypes and guiding individualized management. Recognition of these disorders as markers of impaired cardiovascular-cerebral reserve may improve clinical decisions, reduce falls and cognitive complications, and help preserve function and independence in older adults.