Document Detail

Orthostatic hypotension in the elderly: diagnosis and treatment.
MedLine Citation:
PMID:  17904451     Owner:  NLM     Status:  MEDLINE    
Orthostatic hypotension is a common problem among elderly patients, associated with significant morbidity and mortality. While acute orthostatic hypotension is usually secondary to medication, fluid or blood loss, or adrenal insufficiency, chronic orthostatic hypotension is frequently due to altered blood pressure regulatory mechanisms and autonomic dysfunction. The diagnostic evaluation requires a comprehensive history including symptoms of autonomic nervous system dysfunction, careful blood pressure measurement at various times of the day and after meals or medications, and laboratory studies. Laboratory investigation and imaging studies should be based upon the initial findings with emphasis on excluding diagnoses of neurodegenerative diseases, amyloidosis, diabetes, anemia, and vitamin deficiency as the cause. Whereas asymptomatic patients usually need no treatment, those with symptoms often benefit from a stepped approach with initial nonpharmacological interventions, including avoidance of potentially hypotensive medications and use of physical counter maneuvers. If these measures prove inadequate and the patient remains persistently symptomatic, various pharmacotherapeutic agents can be added, including fludrocortisone, midodrine, and nonsteroidal anti-inflammatory drugs. The goals of treatment are to improve symptoms and to make the patient as ambulatory as possible rather then trying to achieve arbitrary blood pressure goals. With proper evaluation and management, the occurrence of adverse events, including falls, fracture, functional decline, and myocardial ischemia, can be significantly reduced.
Vishal Gupta; Lewis A Lipsitz
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of medicine     Volume:  120     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-01     Completed Date:  2007-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  841-7     Citation Subset:  AIM; IM    
Beth Israel Deaconess Medical Center, Hebrew SeniorLife, and Harvard Medical School, Boston, Mass 02131, USA.
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MeSH Terms
Adrenergic alpha-Agonists / therapeutic use
Aged, 80 and over
Aging / physiology
Anti-Inflammatory Agents / therapeutic use
Blood Pressure Determination / methods
Caffeine / therapeutic use
Central Nervous System Stimulants / therapeutic use
Dose-Response Relationship, Drug
Erythropoietin / therapeutic use
Fludrocortisone / therapeutic use
Geriatrics / methods*
Hypotension, Orthostatic / diagnosis*,  epidemiology,  physiopathology,  therapy*
Midodrine / therapeutic use
Posture / physiology
Prostaglandin Antagonists / therapeutic use
Risk Reduction Behavior
United States / epidemiology
Reg. No./Substance:
0/Adrenergic alpha-Agonists; 0/Anti-Inflammatory Agents; 0/Central Nervous System Stimulants; 0/Prostaglandin Antagonists; 11096-26-7/Erythropoietin; 127-31-1/Fludrocortisone; 42794-76-3/Midodrine; 58-08-2/Caffeine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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