Table of contents

Orthostatic hypotension


Key sources

The following summarized guidelines for the evaluation and management of orthostatic hypotension are prepared by our editorial team based on guidelines from the International Liaison Committee on Resuscitation (ILCOR 2019), the American Heart Association (AHA/HRS/ACC 2017), and the European Federation of Neurological Societies (EFNS 2006). ...
Show more

Diagnostic investigations

Initial evaluation
As per EFNS 2006 guidelines:
Obtain the following as part of the initial evaluation of patients with suspected OH:
structured history taking
detailed physical examination
supine and upright BP measurements
12-lead ECG recording
active standing or head-up tilt, ideally with continuous assessment of BP and HR for 3 min
Obtain further autonomic nervous system screening tests, with other appropriate investigations, depending on the possible etiology of the underlying disorder.
Create free account

More topics in this section

  • Head-up tilt testing

Medical management

As per EFNS 2006 guidelines:
Administer fludrocortisone as first line drug-monotherapy of OH.
Advise patients to maintain a high dietary salt and adequate fluid intake to obtain full benefits from fludrocortisone treatment.

More topics in this section

  • Midodrine

  • Droxidopa

  • Octreotide

Nonpharmacologic interventions

Physical and nutritional measures
As per EFNS 2006 guidelines:
Physical measures that may improve OH include leg crossing, squatting, elastic abdominal binders and stockings, and careful exercise.
Increased water (2-2.5 L/day) and salt ingestion (> 8 g or 150 mmol/day) effectively improve OH.

Therapeutic procedures

Physical counterpressure maneuvers
As per ILCOR 2019 guidelines:
Advise the use of any type of physical counterpressure maneuvers by individuals with acute symptoms of presyncope from vasovagal or orthostatic causes in the first aid setting.
Recognize that we suggest that lower-body physical counterpressure maneuvers such as leg crossing and tensing or squatting are preferable to upper-body and abdominal physical counterpressure maneuvers.

Specific circumstances

Patients with syncope: as per ACC/AHA/HRS 2017 guidelines, advise acute water ingestion in patients with syncope caused by neurogenic OH for occasional, temporary relief.
Show 9 more

Patient education

Physical and nutritional measures: as per EFNS 2006 guidelines, counsel patients on the various factors that influence BP, and specific elements that must be avoided (foods, habits, positions and drugs).