Orthostatic hypotension affects about 22% of older adults and is associated with a 73% increased risk of falls and 50% increased all-cause mortality.
This review emphasizes the need for updated, standardized diagnostic protocols and individualized, multidisciplinary management for orthostatic hypotension in older adults.
Effect estimate: HR 1.73 for falls risk; HR 1.34 for heart failure; HR 1.44 for coronary heart disease; HR 1.64 for stroke; HR 1.51 for atrial fibrillation; 50% increased risk of all-cause mortality
Orthostatic hypotension (OH) is a frequently undiagnosed condition, particularly affecting older adults and individuals with autonomic dysfunction. This comprehensive review offers a unique synthesis of current evidence on the aetiology, prevalence, diagnosis, and management of OH, integrating perspectives from neurology, cardiology, and geriatric medicine. It critically appraises the current limitations within clinical guidelines, highlighting the lack of standardised diagnostic protocols and the inadequate recognition of delayed OH and postural hypertension. Particular focus is given to the older population, proposing individualised diagnostic and therapeutic strategies to address their specific clinical vulnerabilities. By adopting a multidisciplinary, patient-centred framework, the review addresses the complexity of diagnosing and managing OH, emphasising both underutilised non-pharmacological interventions and the careful use of pharmacological therapies. It also calls for the urgent revision of national guidelines, including those by the National Institute for Health and Care Excellence, to align with contemporary evidence and improve clinical decision-making. Future research directions are proposed, particularly regarding symptomatic versus asymptomatic OH, the development of refined diagnostic tools, and the long-term impact of symptom control.
Alsararatee et al. (Tue,) conducted a review in Older adults and individuals with autonomic dysfunction at risk of orthostatic hypotension. Orthostatic hypotension affects about 22% of older adults and is associated with a 73% increased risk of falls and 50% increased all-cause mortality.