Orthostatic hypotension

Defined as a sustained decrease in systolic blood pressure of greater than 20 mm Hg or a decrease of 10 mm Hg or more in diastolic blood pressure when a person moves from a supine to standing position within 3 minutes.

Also known as postural hypotension.

It is common, affecting 18.4% of community dwelling older adults and 22.2% of adults in long-term care facilities.
It affects between 5 and 30% of adults depending on the number of factors, notably age: it can be both a marker, and a mediator of increased morbidity and mortality.

It can be a debilitating disorder with increased risk of falls, major injury, and increased mobility and mortality.

It impedes  upright position and walking, and his predictive of the decreased life expectancy.

May be idiopathic, or related to a central neurological disorder or other entities.

Mild orthostatic hypotension common in elderly.

It is the most common causes of syncope in the elderly because of age and or disease related autonomic dysfunction, volume depletion, and medications.

Postural hypotension is commonly seen in hypovolemia and as a result of various medications: blood pressure-lowering medications, many psychiatric medications, and antidepressants.

Severe symptoms associated with autonomic dysfunction.

Most common symptoms light-headedness, weakness, syncope, headache, bladder dysfunction and impaired balance.

Postprandial hypotension seen in 83% of patients with orthostatic hypotension when monitored by 24-hour blood pressure monitoring.

Associated with a neurological disease in about 45% of patients.

Associated with cardiac arrhythmias.

Can be associated with carotid endarterectomy.

Tilt-table testing useful to confirm the diagnosis.

Frequently associated with renal and cardiovascular diseases.

Half of patients have supine hypertension.

Management is challenging, in many approaches have adverse side effects, including supine hypertension.
Increase salt intake is the corner stone recommendation in management of orthostatic intolerance syndromes.
In patients  with orthostatic intolerance syndromes a systematic review and meta-analysis revealed that increase in salt intake causes a short term increase in blood pressure and time to pre-syncope during orthostasis, with low evidence.
There is no efficacy of salt intake on the long term for falls or cardiovascular risk.

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