Management of Orthostatic Hypotension in Hospitalised Patients: Empirical Evidence, Expert Opinion, and Open Questions

Orthostatic hypotension (OH) is prevalent yet underappreciated among hospitalised adults, affecting more than two-thirds of older inpatients and carrying a considerable burden of falls, cardiovascular events, mortality, prolonged hospitalisations, and readmissions. This article presents practical frameworks for inpatient OH evaluation and management. Standardised measurement protocols and a systematic diagnostic approach aid in identifying neurogenic and non-neurogenic causes. Medication review and nonpharmacological interventions-including fluid administration, behavioural modifications, compression garments, and graduated mobilisation-form the cornerstones of management. Pharmacotherapy should be reserved for refractory cases, guided by autonomic phenotype and side-effect profiles. Coexistent supine hypertension warrants careful consideration. Disposition planning, patient education, and structured follow-up are essential components of care. Important knowledge gaps persist: inpatient OH phenotypes are incompletely characterised, evidence for inpatient interventions is sparse, and validated discharge frameworks are lacking. Greater clinical awareness and translational research are needed to improve outcomes for this vulnerable population.