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Pharmacological Interventions for Orthostatic Hypotension: A Systematic Review
Anushka Verma1, Eiman Saraya2, Mehjabin S Haque3
1Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND.
Cureus
|September 15, 2025
Summary
Pharmacological treatments effectively manage orthostatic hypotension (OH), a condition causing blood pressure drops upon standing. Droxidopa and midodrine are recommended first-line therapies, with others showing moderate benefits, but personalized approaches are crucial.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Orthostatic hypotension (OH) is a common, debilitating condition affecting older adults and those with neurodegenerative disorders.
- OH significantly impairs quality of life, increasing risks of falls, syncope, morbidity, and mortality.
Purpose of the Study:
- To systematically review the efficacy and safety of pharmacological treatments for orthostatic hypotension.
- To evaluate evidence for various drug classes used in OH management.
Main Methods:
- Systematic review adhering to PRISMA 2020 guidelines, analyzing 25 RCTs and NRCTs.
- Quality assessment using Cochrane ROB 2, JBI Checklist, and NOS.
- Evidence certainty evaluated with the GRADE framework.
Main Results:
- FDA-approved droxidopa and midodrine demonstrate consistent efficacy as first-line OH treatments.
- Atomoxetine and fludrocortisone show moderate efficacy; pyridostigmine offers adjunctive benefits.
- Octreotide shows potential for refractory OH, but evidence is limited. Common adverse effects include supine hypertension and dizziness.
Conclusions:
- Pharmacological interventions offer significant benefits for managing orthostatic hypotension symptoms.
- Personalized treatment strategies are essential to balance efficacy and tolerability, minimizing adverse effects.
- Further comparative and long-term studies are needed to optimize therapeutic approaches for OH.
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