Orthostatic hypotension: Review and expert position statement

E Vidal-Petiot; A Pathak; J-P Azulay; A Pavy-Le Traon; O Hanon

doi:10.1016/j.neurol.2023.11.001

Orthostatic hypotension: Review and expert position statement

Rev Neurol (Paris). 2024 Jan-Feb;180(1-2):53-64. doi: 10.1016/j.neurol.2023.11.001. Epub 2023 Dec 19.

Authors

E Vidal-Petiot¹, A Pathak², J-P Azulay³, A Pavy-Le Traon⁴, O Hanon⁵

Affiliations

¹ Service de physiologie, ESH Excellence Center, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France; INSERM U1148, Université Paris-Cité and Université Sorbonne Paris Nord, LVTS, 75018 Paris, France. Electronic address: emmanuelle.vidal-petiot@aphp.fr.
² Service de cardiologie, ESH Excellence Center, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98000 Monaco, France.
³ Service de neurologie et pathologie du mouvement, hôpital de la Timone, 13385 Marseille cedex 05, France.
⁴ Service de neurologie, CHU de Toulouse, 31059 Toulouse cedex, France; UMR 1297, institut des maladies métaboliques et cardiovasculaires, Toulouse, France.
⁵ Service de gériatrie, université Paris-Cité, EA4468, hôpital Broca, AP-HP, 75013 Paris, France.

PMID: 38123372
DOI: 10.1016/j.neurol.2023.11.001

Abstract

Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20mmHg or a drop in diastolic blood pressure of at least 10mmHg within 3minutes of standing. It is a common disorder, especially in high-risk populations such as elderly subjects and patients with neurological diseases, and is associated with markedly increased morbidity and mortality. Its management can be challenging, particularly in cases where supine hypertension is associated with severe orthostatic hypotension. Education of the patient, non-pharmacological measures, and drug adaptation are the cornerstones of treatment. Pharmacological treatment should be individualized according to the severity, underlying cause, 24-hour blood pressure profile, and associated coexisting conditions. First-line therapies are midodrine and fludrocortisone, which may need to be combined for optimal care of severe cases.

Keywords: Autonomic failure; Hypertension; Orthostatic hypotension.

Publication types

Review
Consensus Statement

MeSH terms

Aged
Blood Pressure
Humans
Hypertension* / complications
Hypertension* / drug therapy
Hypotension, Orthostatic* / diagnosis
Hypotension, Orthostatic* / epidemiology
Hypotension, Orthostatic* / etiology
Midodrine* / therapeutic use
Nervous System Diseases* / complications

Substances

Midodrine