Open AccessOrthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations
Author(s) -
Magkas Nikolaos,
Tsioufis Costas,
Thomopoulos Costas,
Dilaveris Polychronis,
Georgiopoulos Georgios,
Sanidas Elias,
Papademetriou Vasilios,
Tousoulis Dimitrios
Publication year - 2019
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.13521
Subject(s) - medicine , orthostatic vital signs , adverse effect , supine position , intensive care medicine , coronary artery disease , disease , stroke (engine) , pathophysiology , quality of life (healthcare) , orthostatic intolerance , psychological intervention , blood pressure , psychiatry , mechanical engineering , nursing , engineering
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.