Orthostatic hypotension due to autonomic disorders in the hypertension clinic

Hypertension specialists are consulted regarding orthostatic hypotension (OH) or the combination of OH with supine hypertension. These clinical presentations are often associated with a variety of underlying autonomic disorders. A comprehensive medical history and clinical examination with attention to autonomic signs and the neurological system may suggest the possible etiology or a differential diagnosis. At times, drug therapy for hypertension or other diseases such as Parkinson's is temporally associated with the onset of OH. At other times, no definitive association can be made. Most hypertension specialists can initiate basic evaluation and treatment. Treatment approaches to OH must be targeted primarily to alleviate symptoms of cerebral hypoperfusion and also be cognizant of supine hypertension. Several lifestyle and drug therapies can ameliorate symptoms of OH. Short-acting antihypertensive therapy may be useful in controlling nocturnal supine hypertension.