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Non-pharmacological management of orthostatic hypotension in the older patient

Published online by Cambridge University Press:  20 December 2011

Daniel J Ryan ,
Conal J Cunningham  and
Chie Wei Fan
Daniel J Ryan*
Affiliation:
Falls and Blackouts Unit, St James Hospital, Dublin, Ireland
Conal J Cunningham
Affiliation:
Falls and Blackouts Unit, St James Hospital, Dublin, Ireland
Chie Wei Fan
Affiliation:
Falls and Blackouts Unit, St James Hospital, Dublin, Ireland
*
Address for correspondence: Dr Daniel Ryan, Falls and Blackouts Unit, St James Hospital, Dublin 8, Ireland. Email: [email protected]
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Summary

Orthostatic hypotension (OH) occurs in up to 30% of community-dwelling older people. Its presence confers a greater risk of incident co-morbid disease and all-cause mortality. As per guidelines, first-line treatment should consist of non-pharmacological therapies. Effective lifestyle modification advice includes the avoidance of rapid postural changes and large meals. Physical counter-manoeuvres, when comprehensively described, effectively abate symptom progression. Patients should drink 1.5 to 2 litres of water daily, though reports suggest only half of older people comply with this regime. Moderate salt consumption is advised, though with caution as supine hypertension often co-exists. Compression hosiery benefits older people and, contrary to popular opinion, is well tolerated. Potential, future therapies include impedance threshold devices. Older patients with OH frequently have co-morbid disease such that a pharmacological approach is ill-advised. They respond well to non-pharmacological therapies and these should form the primary therapeutic approach.

Keywords

orthostatic hypotensiontherapeuticsfallsdizzinesssyncope
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 22 , Issue 2 , May 2012 , pp. 119 - 129
Copyright
Copyright © Cambridge University Press 2011

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