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Management of orthostatic hypotension
1Department of Pharmacy Services, University of Michigan Medical Center, Ann Arbor 48109-0008.
American Journal of Hospital Pharmacy
|March 1, 1994
Summary
Orthostatic hypotension (OH) is a blood pressure drop upon standing, causing lightheadedness or syncope. Management focuses on symptom relief through non-drug methods and cautious pharmacological interventions.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Orthostatic hypotension (OH) defined as a significant drop in blood pressure upon postural change.
- OH leads to symptoms of cerebral hypoperfusion, including lightheadedness and syncope.
- Risk factors include autonomic disorders, reduced blood volume, diabetes, medications, and advanced age.
Purpose of the Study:
- To review the pathogenesis, clinical manifestations, and management strategies for orthostatic hypotension.
- To highlight diagnostic criteria based on postural hypotension and ischemic symptoms.
- To discuss therapeutic goals and available treatment options.
Main Methods:
- Review of existing literature on orthostatic hypotension.
- Analysis of diagnostic approaches.
- Evaluation of non-pharmacologic and pharmacologic treatment modalities.
Main Results:
- Diagnosis requires documentation of postural hypotension with cerebral ischemia symptoms.
- Non-pharmacologic treatments (sodium intake, elastic garments, avoiding postural changes) are preferred.
- Pharmacologic options like fludrocortisone acetate, prostaglandin synthetase inhibitors, and others exist but require careful monitoring due to variable responses and side effects.
Conclusions:
- Orthostatic hypotension management aims to alleviate symptoms.
- Non-pharmacologic approaches are foundational.
- Effective treatment often involves a combination of non-drug and drug therapies, tailored to individual patient needs and disease severity.