Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 May;21(5):546-554.
doi: 10.1111/jch.13521. Epub 2019 Mar 22.

Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations

Nikolaos Magkas  1 , Costas Tsioufis  1 , Costas Thomopoulos  2 , Polychronis Dilaveris  1 , Georgios Georgiopoulos  1 , Elias Sanidas  3 , Vasilios Papademetriou  4 , Dimitrios Tousoulis  1
Affiliations
Review

Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations

Nikolaos Magkas et al. J Clin Hypertens (Greenwich). 2019 May.

Abstract

Orthostatic hypotension (OH), that is blood pressure fall when standing from the supine to the erect position, is a common cardiovascular disorder, highly prevalent in elderly and frail individuals and in patients with multiple comorbidities. Orthostatic hypotension is considered a manifestation of dysfunction of the autonomic nervous system, caused or facilitated by several neurological or non-neurological diseases and conditions, while its clinical significance is increasingly recognized as a cause of impairment of quality of life and potentially of worse outcomes. Indeed, OH has been extensively studied and numerous prospective cohort studies support its association with adverse events, including coronary artery disease, heart failure, stroke, cognitive dysfunction, and, most importantly, mortality rates. Specific pharmacological and non-pharmacological interventions have been established for the treatment of OH. However, randomized data evaluating the impact of therapeutic interventions on morbidity and mortality outcomes are lacking. Thus, despite that OH seems to have important prognostic implications indicated by several reported associations with adverse events, it remains unclear whether OH treatment could improve prognosis. In the present review, we discuss the clinical applications associated with ΟΗ by outlining the current perspectives on ΟΗ definition, diagnosis, pathophysiology, prognostic role, and treatment.

Keywords: autonomic nervous system; blood pressure; cardiovascular outcomes; neurogenic; orthostatic hypotension.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
The pathophysiology of autonomic failure resulting in orthostatic hypotension. The afferent pathway transfers information from the baroreceptors to the central nervous system, and the efferent pathway regulates the compensatory responses of the cardiovascular system. From 2018 European Society of Cardiology syncope guidelines, after permission.5 ANS, autonomic nervous system
Figure 2
Figure 2
Classification of the main causes of orthostatic hypotension. ACEI, angiotensin‐converting enzyme; ARB, angiotensin receptor bloacker; HIV, human immunodeficiency virus
Figure 3
Figure 3
Treatment options for orthostatic hypotension. BP, blood pressure; OH, orthostatic hypotensin
See this image and copyright information in PMC

References

    1. Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: epidemiology, prognosis, and treatment. J Am Coll Cardiol. 2015;66(7):848‐860. - PubMed
    1. Shibao C, Lipsitz LA, Biaggioni I. ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens (Greenwich). 2013;15(3):147‐153. - PMC - PubMed
    1. Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883‐1948. - PubMed
    1. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69‐72. - PubMed
    1. Brignole M, Moya A, de Lange FJ, et al. Practical instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):e43‐e80. - PubMed