January 14, 2013Open Access
ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension
Key Result
Stepwise management of orthostatic hypotension using physiological countermeasures followed by pharmacologic agents like fludrocortisone or midodrine is recommended to alleviate symptoms and reduce falls.
Structured PICO
P
Population
Patients with orthostatic hypotension, including frail elderly, hypertensive, and hospitalized patients, as well as those with neurogenic orthostatic hypotension.
I
Intervention
Evaluation and stepwise management using behavioral, nonpharmacologic (e.g., compression stockings, abdominal binders, water drinking, high-salt diet), and pharmacologic strategies (e.g., fludrocortisone, midodrine, atomoxetine, pyridostigmine).
This position paper provides practical recommendations for the evaluation and stepwise management of orthostatic hypotension using physiological countermeasures and pharmacologic therapies.
Limitations
- Research in this area is mostly limited to studies in small numbers of patients.
- Trials of the type needed to develop evidence-based guidelines are not available for this condition.
Abstract
This paper provides recommendations on the treatment of orthostatic hypotension (OH) as reviewed by the American Society of Hypertension. It focuses on recent reports on the evaluation and management of OH and provides practical advice for clinicians on how to screen, diagnose, and treat patients using behavioral, nonpharmacologic, and pharmacologic strategies. The authors also provide a stepwise approach on how to apply new findings to successfully control OH and reduce the risk of syncope and falls in these patients. Treatment of OH is also discussed in special situations such as in hypertensive and hospitalized patients. It should be noted, however, that research in this area is mostly limited to studies in small numbers of patients. Unfortunately, the trials of the type needed to develop evidence-based guidelines are not available for this condition.