What treatment options are available for postural hypotension?
Postural (orthostatic) hypotension is defined by a drop of >20 mm Hg in systolic pressure or a fall of > 10 mm Hg in diastolic pressure on sitting or standing from the prone position [Merck Manual of Geriatrics 1999]. Presence of symptoms (i.e. dizziness, light-headedness or fainting) may be more clinically important. It is particularly common in older persons but also commonly accompanies Parkinson’s disease. Non-drug management strategies are preferred and may include sleeping with the head of the bed tilted up and the relaxing of salt restrictions. Patients with symptomatic postural hypotension need to sit for a period before ambulating from the lying position.Specific drug treatment of orthostatic hypotension is occasionally necessary. Fludrocortisone (Florinef) is commonly used to treat patients who are symptomatic. Ephedrine, caffeine, NSAIDs, dihydroergotamine and octreotide are other less common therapies available.
