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New Horizons in orthostatic hypotension

Lookup NU author(s): Dr James Frith, Dr Steve Parry

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Abstract

© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. Background: orthostatic hypotension (OH) is a common disabling condition associated with increased morbidity and mortality. Much of the evidence available is derived from younger populations with chronic neurological disease leading to uncertainty for the diagnosis and management of older people. Objective: to provide an overview of recent and emerging evidence for the diagnosis, management and prognosis of OH in older persons. Methods: a narrative review of recent studies, emerging therapies and relevant regulatory updates. Findings: revisions to the diagnostic criteria for OH include the duration of the blood pressure drop, specific criteria for initial and delayed OH and OH with hypertension. Non-drug therapies remain the first-line treatment option and Comprehensive Geriatric Assessment appears to result in lower rates of OH. Recent evidence concerning withdrawal of causative medication is inconsistent. Midodrine has recently become the only licenced medication for OH in the UK. Other emerging treatments include atomoxetine and droxidopa but these require further evaluation. Many other agents may be used but are not supported by high-quality evidence. The increase in mortality associated with OH is less apparent in older people. Summary: OH remains common in older people, the new diagnostic criteria address some of the previous uncertainty but evidence concerning withdrawal of antihypertensives is conflicting. Midodrine is now the only licenced medication for OH in the UK, but non-drug therapies remain first line and fludrocortisone may be considered before midodrine. We may see other agents such as droxidopa becoming increasingly used over the coming years.


Publication metadata

Author(s): Frith J, Parry SW

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2017

Volume: 46

Issue: 2

Pages: 168-174

Print publication date: 01/03/2017

Online publication date: 18/11/2016

Acceptance date: 02/04/2016

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: https://doi.org/10.1093/ageing/afw211

DOI: 10.1093/ageing/afw211


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