Non-pharmacological management of orthostatic hypotension in the older patient

Abstract

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.

Syncope causes transient focal neurological symptoms

“…These included avoidance of triggers, lifestyle modification, increase in fluid and salt intake, physical counter manoeuvres, reduction or withdrawal of culprit medication, prescription of midodrine and/or fludrocortisone, cardiac pacing, etc. 1,19 FN cases were followed up for mean 24 months after intervention to ascertain whether recurrent FN occurred.…”