[Orthostatic hypotension: which initial cardiovascular and biological explorations? Which therapeutic solutions? The place of recommendations]

Abstract

Orthostatic hypotension (OHT) is a common symptom that affects about 1% of the population. Its prevalence increases with age. In addition to the morbidity related to falls and syncope, OHT is a risk factor for cognitive decline and cerebrovascular morbidity and mortality. In most cases, its cause is easily found by the examination and some simple explorations. For severe and/or less obvious mechanism, some paraclinical methods of investigation can be proposed. These include head upright tilt-test and Valsalva maneuver. Both explore the entire baroreflex arc, and are realised by non-invasive measurements of heart rate and blood pressure. Other tests explore more specifically the parasympathetic outflow tract or sympathetic. In some situations cardiac MIBG scintigraphy and urinary catecholamines may be useful. The respective choice of these tests depends on the clinical setting and suspected type of dysautonomic lesion. Identifying the cause and assessment of functional impairment guide the therapeutic choices, which are primarily based on non-pharmacological approach.