ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension

Authors

  • Cyndya Shibao MD,

    1. Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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  • Lewis Arnold Lipsitz MD,

    1. Division of Gerontology, Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA
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  • Italo Biaggioni MD

    Corresponding author
    • Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Address for correspondence: Italo Biaggioni, MD, Division of Clinical Pharmacology, Department of Medicine, 556 Robinson Research Building, Nashville, TN 37232-8802

E-mail: italo.biaggioni@vanderbilt.edu

Abstract

This paper provides recommendations on the treatment of orthostatic hypotension (OH) as reviewed by the American Society of Hypertension. It focuses on recent reports on the evaluation and management of OH and provides practical advice for clinicians on how to screen, diagnose, and treat patients using behavioral, nonpharmacologic, and pharmacologic strategies. The authors also provide a stepwise approach on how to apply new findings to successfully control OH and reduce the risk of syncope and falls in these patients. Treatment of OH is also discussed in special situations such as in hypertensive and hospitalized patients. It should be noted, however, that research in this area is mostly limited to studies in small numbers of patients. Unfortunately, the trials of the type needed to develop evidence-based guidelines are not available for this condition.

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