Treatment of orthostatic and postprandial hypotension
- Horacio Kaufmann, MD
Horacio Kaufmann, MD
- Professor of Neurology and Medicine
- New York University School of Medicine
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
When autonomic reflexes are impaired or intravascular volume is markedly depleted, a significant reduction in blood pressure occurs upon standing (ie, orthostatic hypotension). Orthostatic hypotension can cause dizziness, syncope, and even angina or stroke.
Symptomatic falls in blood pressure after standing or eating are a frequent clinical problem. The prevalence of orthostatic hypotension varies from 5 to 20 percent in different reports. Many disorders can cause orthostatic hypotension, which can also be a symptom of acute or chronic volume depletion. A related problem, postprandial hypotension (a fall in blood pressure occurring 15 to 90 minutes after meals) is also common in older patients. Orthostatic hypotension can be a disabling condition and is also a risk factor for cardiovascular and all-cause mortality, as well as falls with attendant morbidity.
This topic will review the treatment of chronic orthostatic and postprandial hypotension. The patient with acute orthostatic hypotension due to volume depletion should be treated with volume replacement.
The causes and evaluation of orthostatic hypotension are discussed separately. POTS is also discussed separately (See "Mechanisms, causes, and evaluation of orthostatic hypotension" and "Postural tachycardia syndrome".)
The following sections on therapy are directed toward the patient with chronic orthostatic hypotension due to autonomic dysfunction. The patient with acute orthostatic hypotension due to volume depletion should be treated with volume replacement.
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- NONPHARMACOLOGIC MEASURES
- Removal of offending medications
- Lifestyle modification
- Physical maneuvers
- Increased salt and water intake
- Modification of meals
- Sympathomimetic agents
- - Midodrine
- Supplementary agents
- - Erythropoietin
- - Caffeine
- - Pyridostigmine
- - Nonsteroidal antiinflammatory drugs
- Third line and experimental agents
- SUPINE HYPERTENSION
- TREATMENT OF POSTPRANDIAL HYPOTENSION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS