• Amr Wahba, Cyndya A Shibao, MuldowneyJames A SJASDepartment of Medicine; Cardiovascular Medicine., Amanda Peltier, Ralf Habermann, and Italo Biaggioni.
• Department of Medicine; Division of Clinical Pharmacology.
• Am. J. Med. 2022 Jan 1; 135 (1): 243124-31.

AbstractOrthostatic hypotension is a frequent cause of falls and syncope, impairing quality of life. It is an independent risk factor of mortality and a common cause of hospitalizations, which exponentially increases in the geriatric population. We present a management plan based on a systematic literature review and understanding of the underlying pathophysiology and relevant clinical pharmacology. Initial treatment measures include removing offending medications and avoiding large meals. Clinical assessment of the patients' residual sympathetic tone can aid in the selection of initial therapy between norepinephrine "enhancers" or "replacers." Role of splanchnic venous pooling is overlooked, and applying abdominal binders to improve venous return may be effective. The treatment goal is not normalizing upright blood pressure but increasing it above the cerebral autoregulation threshold required to improve symptoms. Hypertension is the most common associated comorbidity, and confining patients to bed while using pressor agents only increases supine blood pressure, leading to worsening pressure diuresis and orthostatic hypotension. Avoiding bedrest deconditioning and using pressors as part of an orthostatic rehab program are crucial in reducing hospital stay.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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