Recognition of orthostatic hypotension and postprandial hypotension is important, regardless of whether they are causing symptoms, because they are associated with recurrent falls, heart disease, stroke and increased cardiovascular and all-cause morbidity and mortality. Initial management focuses on nonpharmacological measures and includes review of medications.
- Supine nocturnal hypertension occurs in up to 80% of patients with orthostatic hypotension (OH).
- Postprandial hypotension (PPH) should be considered in a patient who experiences falls or syncope in the first two hours after commencing a meal.
- OH and PPH are most commonly seen in hypertensive elderly patients who have multiple comorbidities and are taking multiple medications. In this group, judicious control of hypertension is recommended, with ACE inhibitors or angiotensin II inhibitors recommended as first-line therapies.
- Marked OH and PPH occur in patients with autonomic failure. In this situation, the underlying cardiovascular defect cannot be cured and management of OH and PPH is directed towards control of symptoms and attenuation of the fall in blood pressure.