Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem

Circ Arrhythm Electrophysiol. 2022 Mar;15(3):e010573. doi: 10.1161/CIRCEP.121.010573. Epub 2022 Feb 25.


Orthostatic hypotension (OH), a common, often overlooked, disorder with many causes, is associated with debilitating symptoms, falls, syncope, cognitive impairment, and risk of death. Chronic OH, a cardinal sign of autonomic dysfunction, increases with advancing age and is commonly associated with neurodegenerative and autoimmune diseases, diabetes, hypertension, heart failure, and kidney failure. Management typically involves a multidisciplinary, patient-centered, approach to arrive at an appropriate underlying diagnosis that is causing OH, treating accompanying conditions, and providing individually tailored pharmacological and nonpharmacological treatment. We propose a novel streamlined pathophysiological classification of OH; review the relationship between the cardiovascular disease continuum and OH; discuss OH-mediated end-organ damage; provide diagnostic and therapeutic algorithms to guide clinical decision making and patient care; identify current gaps in knowledge and try to define future research directions. Using a case-based learning approach, specific clinical scenarios are presented highlighting various presentations of OH to provide a practical guide to evaluate and manage patients who have OH.

Keywords: cardiovascular diseases; heart failure; hypertension; orthostatic hypotension; patient care.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases* / complications
  • Cognitive Dysfunction* / complications
  • Humans
  • Hypertension* / complications
  • Hypotension, Orthostatic* / diagnosis
  • Hypotension, Orthostatic* / etiology
  • Hypotension, Orthostatic* / therapy
  • Syncope