Orthostatic hypotension
Classic, initial and delayed orthostatic hypotension and postprandial hypotension in older people, how to measure it properly, drug culprits and prescribing cascades, the 2024 AHA position on antihypertensives, and a stepwise plan through to midodrine and fludrocortisone.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Common in older people: about 1 in 5 over 65 and up to half in residential care or hospital. Often asymptomatic.
- Linked to falls, syncope, fractures, cognitive decline, stroke, heart failure and death. Even asymptomatic OH predicts harm.
- Most OH in older people is multifactorial and drug-related, not primary autonomic failure.
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Sources
- Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome (Freeman R et al. Clin Auton Res 2011;21:69-72)American Autonomic Society and European Federation of Autonomic Societies, 2011
- 2018 ESC Guidelines for the diagnosis and management of syncopeEuropean Society of Cardiology, 2018
- Orthostatic hypotension in adults with hypertension: a scientific statement from the American Heart Association (Juraschek SP et al. Hypertension 2024;81(3):e16-e30)American Heart Association (Hypertension), 2024
- Orthostatic hypotension, hypertension treatment, and cardiovascular disease: an individual participant meta-analysis (Juraschek SP et al. JAMA 2023;330:1459-71)JAMA, 2023
- Diagnosis and treatment of orthostatic hypotension (Wieling W et al. Lancet Neurol 2022;21:735-46)The Lancet Neurology, 2022
- AusPAR: midodrine hydrochloride (Midodrine SCP, Midodrine ANS, Vasodrine)AU/NZTherapeutic Goods Administration, 2019 registration
- 2024 ESC Guidelines for the management of elevated blood pressure and hypertension (McCarthy CP et al. Eur Heart J 2024;45:3912-4018)European Society of Cardiology, 2024
- Guideline for the diagnosis and management of hypertension in adults 2016AU/NZNational Heart Foundation of Australia, 2016 (still current; the Heart Foundation page, updated October 2026, says a new hypertension guideline is coming soon, re-check)
- Therapeutic Guidelines: Cardiovascular and Neurology (eTG complete)AU/NZTherapeutic Guidelines Limited, topic version not verified
- World guidelines for falls prevention and management for older adults: a global initiative (Montero-Odasso M et al. Age Ageing 2022;51:afac205)Age and Ageing, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy