Orthostatic hypotension, defined as a systolic blood pressure reduction of at least 20 mm Hg, can be managed with nonpharmacologic measures and agents like fludrocortisone and midodrine.
This review outlines the pathophysiology, diagnosis, and management strategies for orthostatic hypotension and vasovagal syncope, highlighting the utility of both nonpharmacologic and pharmacologic interventions.
Orthostatic hypotension (OH) occurs in 0.5% of individuals and as many as 7-17% of patients in acute care settings. Moreover, OH may be more prevalent in the elderly due to the increased use of vasoactive medications and the concomitant decrease in physiologic function, such as baroreceptor sensitivity. OH may result in the genesis of a presyncopal state or result in syncope. OH is defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing. A review of symptoms, and measurement of supine and standing BP with appropriate clinical tests should narrow the differential diagnosis and the cause of OH. The fall in BP seen in OH results from the inability of the autonomic nervous system (ANS) to achieve adequate venous return and appropriate vasoconstriction sufficient to maintain BP. An evaluation of patients with OH should consider hypovolemia, removal of offending medications, primary autonomic disorders, secondary autonomic disorders, and vasovagal syncope, the most common cause of syncope. Although further research is necessary to rectify the disease process responsible for OH, patients suffering from this disorder can effectively be treated with a combination of nonpharmacologic treatment, pharmacologic treatment, and patient education. Agents such as fludrocortisone, midodrine, and selective serotonin reuptake inhibitors have shown promising results. Treatment for recurrent vasovagal syncope includes increased salt and water intake and various drug treatments, most of which are still under investigation.
Medow et al. (Wed,) conducted a review in Orthostatic hypotension and vasovagal syncope. Pharmacologic and nonpharmacologic treatments was evaluated. Orthostatic hypotension, defined as a systolic blood pressure reduction of at least 20 mm Hg, can be managed with nonpharmacologic measures and agents like fludrocortisone and midodrine.