Orthostatic hypotension: focus on a common pathology sometimes misknowned

Area of Science:

• Geriatrics
• Cardiology
• Neurology

Background:

• Orthostatic hypotension (OH) is prevalent in older adults and hospitalized patients, increasing with age.
• Defined by a significant drop in blood pressure upon standing (≥20 mmHg systolic or ≥10 mmHg diastolic).
• Associated with adverse outcomes including falls, neurodegenerative diseases, cardiovascular events, and mortality.

Purpose of the Study:

• To review the pathophysiology, diagnosis, and management of orthostatic hypotension.
• To highlight the association of OH with various adverse health outcomes.
• To discuss current therapeutic strategies for OH.

Main Methods:

• Literature review focusing on orthostatic hypotension prevalence, mechanisms, and clinical impact.
• Analysis of diagnostic criteria and etiological workup, including cardiac response and autonomic function testing.
• Evaluation of non-pharmacological and pharmacological treatment options.

Main Results:

• Prevalence of OH is approximately 30% in individuals over 65 years old.
• Pathogenesis involves neurogenic (autonomic failure) and non-neurogenic (hypovolemia) mechanisms, often influenced by medications.
• Etiological workup is crucial for targeted management.

Conclusions:

• Effective management of orthostatic hypotension is essential to mitigate associated risks.
• Non-pharmacological therapies like leg compression are used, though evidence is limited.
• Pharmacological interventions are often required for neurogenic orthostatic hypotension.