• Melanie Dani, Andreas Dirksen, Patricia Taraborrelli, Dimitrios Panagopolous, Miriam Torocastro, Richard Sutton, and LimPhang BoonPBHammersmith Hospital, London, UK..
• Hammersmith Hospital, London, UK and Imperial College London, London, UK melanie.dani@nhs.net.
• Clin Med (Lond). 2021 May 1; 21 (3): e275e282e275-e282.

AbstractOrthostatic hypotension (OH) is very common in older people and is encountered daily in emergency departments and medical admissions units. It is associated with a higher risk of falls, fractures, dementia and death, so prompt recognition and treatment are essential. In this review article, we describe the physiology of standing (orthostasis) and the pathophysiology of orthostatic hypotension. We focus particularly on aspects pertinent to older people. We review the evidence and consensus management guidelines for all aspects of management. We also tackle the challenge of concomitant orthostatic hypotension and supine hypertension, providing a treatment overview as well as practical suggestions for management. In summary, orthostatic hypotension (and associated supine hypertension) are common, dangerous and disabling, but adherence to simple structures management strategies can result in major improvements.© Royal College of Physicians 2021. All rights reserved.

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