[Arterial hypertension with orthostatic hypotension]

Arterial hypertension (AH) with orthostatic hypotension (OH) is quite important clinical problem, present especially in older age and in various forms of autonomic nervous system (ANS) failure. ANS damage may be primary, or secondary, most offen in diabetes mellitus. In older age OH occurrence is about 30% and postprandial hypotension is also possible. Various antihypertensive drugs, also tricyclic antidepressants, alpha1-adrenergic receptors antagonists and diuretics may provoke OH. Diagnostic value has simple screening bedside orthostatic test, respectively head up tilt table test and cardiovascular reflex tests. Therapy is non-medicamentous with enough fluids, compression of legs and higher head and neck position in the night. AH with OH can be treated with short-acting antihypertensive drugs, eventually with transdermal nitroglycerin. OH can be treated with clonidine, midodrine, fludrocortisone or beta1-blocker.