Highlights & Basics
- Orthostatic hypotension is an independent predictor of mortality and the cause of significant morbidity associated with falls.
- A common problem in frail older people. Orthostatic hypotension-related hospitalizations increase markedly with age.
- Common causes include drugs (e.g., alpha-blockers, including tamsulosin [used for treating conditions such as benign prostatic hypertrophy], central sympatholytics, including tizanidine [used as a muscle relaxant], and diuretics), diseases causing peripheral neuropathy (e.g., diabetes mellitus), Parkinson disease, and dementia with Lewy bodies.
- Primary neurodegenerative disorders of the autonomic nervous system (pure autonomic failure, and multiple system atrophy or Shy-Drager syndrome) are less common, but cause severe orthostatic hypotension.
- Acute or subacute onset should suggest an autoimmune or paraneoplastic disorder.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Kaufmann H, Biaggioni I. Autonomic failure in neurodegenerative disorders. Semin Neurol. 2003 Dec;23(4):351-63.[Abstract]
Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017 Aug;264(8):1567-82.[Abstract][Full Text]
Lahrmann H, Cortelli P, Hilz M, et al. EFNS guidelines on orthostatic hypotension. In: Gilhus NE, Barnes MP, Brainin M (eds). European Handbook of Neurological Management. Vol 1, 2nd ed. Oxford: Wiley-Blackwell; 2011.
Shibao C, Lipsitz LA, Biaggioni I; American Society of Hypertension Writing Group. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013 Jul-Aug;7(4):317-24.[Abstract][Full Text]
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