Skip to content
2000
image of Orthostatic Hypotension in Older Adults: A Narrative Review of Causes, Drug Impacts, and Management Strategies

Abstract

Introduction

Orthostatic hypotension (OH) is a prevalent disorder among the elderly, characterized by a marked decrease in blood pressure upon standing. It impacts 10–30% of elderly individuals and is linked to falls, cognitive deterioration, and cardiovascular issues. The primary factors include aging, autonomic dysfunction, and pharmaceutical usage.

Methods

This narrative review consolidates and examines contemporary research regarding the etiology, pharmacological effects, diagnosis, and treatment of orthostatic hypotension in elderly adults. A systematic technique was not employed; rather, expert analysis of the existing literature was utilized to distill essential ideas.

Results

OH in the elderly is frequently complex. Frequently involved drugs encompass diuretics, β-blockers, calcium channel blockers, ACE inhibitors, antidepressants, and antiparkinsonian therapies. These medications, within the framework of age-associated physiological alterations, elevate the risk of orthostatic hypotension. The diagnosis relies on monitoring blood pressure during changes in posture. Non-pharmacological interventions, including water, sodium consumption, compression garments, and physical movements, constitute first-line therapies. In chronic instances, pharmacological treatments such as midodrine, droxidopa, and fludrocortisone may be employed, albeit with vigilant monitoring due to potential deleterious effects.

Discussion

OH significantly affects the autonomy and quality of life of elderly individuals. Medication-induced orthostatic hypotension is frequently disregarded, particularly in the context of polypharmacy. Customized management, encompassing drug evaluation and integrated therapy approaches, is crucial. Clinical monitoring and regular orthostatic evaluations are essential for prompt diagnosis and management.

Conclusion

Effective OH management requires a personalized, multidisciplinary approach. Future research should focus on identifying reliable diagnostic biomarkers and developing individualized treatment algorithms to improve patient outcomes and support healthy aging.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/chyr/10.2174/0115734021380889250919160828
2025-10-10
2025-11-16

  • From This Site

    /content/journals/chyr/10.2174/0115734021380889250919160828
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Cautela J. Tartiere J.M. Cohen-Solal A. Management of low blood pressure in ambulatory heart failure with reduced ejection fraction patients. Eur. J. Heart Fail. 2020 22 8 1357 1365 10.1002/ejhf.1835 32353213
    [Google Scholar]
  2. Gibbons C.H. Schmidt P. Biaggioni I. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J. Neurol. 2017 264 8 1567 1582 10.1007/s00415‑016‑8375‑x 28050656
    [Google Scholar]
  3. Ware W.A. Bonagura J.D. Scansen B.A. The normal cardiovascular system. In:Cardiovascular Disease in Companion Animals. CRC Press 2021 3 32 10.1201/9780429186639‑2
    [Google Scholar]
  4. Smith D.L. Fernhall B. Advanced cardiovascular exercise physiology. Human Kinetics 2023 10.5040/9781718243859
    [Google Scholar]
  5. Tessmer C. Cerebrovascular and cardiovascular responses to lower body negative pressure and posture change in the elderly. University of Waterloo 2012
    [Google Scholar]
  6. Rivasi G. Rafanelli M. Mossello E. Brignole M. Ungar A. Drug-related orthostatic hypotension: Beyond anti-hypertensive medications. Drugs Aging 2020 37 10 725 738 10.1007/s40266‑020‑00796‑5 32894454
    [Google Scholar]
  7. Kario K. Orthostatic hypertension—A new haemodynamic cardiovascular risk factor. Nat. Rev. Nephrol. 2013 9 12 726 738 10.1038/nrneph.2013.224 24189649
    [Google Scholar]
  8. Ricci F. De Caterina R. Fedorowski A. Orthostatic Hypotension. J. Am. Coll. Cardiol. 2015 66 7 848 860 10.1016/j.jacc.2015.06.1084 26271068
    [Google Scholar]
  9. Khemani P. Mehdirad A.A. Cardiovascular disorders mediated by autonomic nervous system dysfunction. Cardiol. Rev. 2020 28 2 65 72 10.1097/CRD.0000000000000280 31764015
    [Google Scholar]
  10. Shieh Y. Eklund M. Sawaya G.F. Black W.C. Kramer B.S. Esserman L.J. Population-based screening for cancer: Hope and hype. Nat. Rev. Clin. Oncol. 2016 13 9 550 565 10.1038/nrclinonc.2016.50 27071351
    [Google Scholar]
  11. Avinash S.A. Neurocognitive and psychophysiological changes associated with Kumbhaka–yogic breath holding. Thesis PHD 2018
    [Google Scholar]
  12. Mendoza-Velásquez J.J. Flores-Vázquez J.F. Barrón-Velázquez E. Sosa-Ortiz A.L. Illigens B.M.W. Siepmann T. Autonomic Dysfunction in α-Synucleinopathies. Front. Neurol. 2019 10 363 10.3389/fneur.2019.00363 31031694
    [Google Scholar]
  13. Calvet D. Touzé E. Varenne O. Sablayrolles J.L. Weber S. Mas J.L. Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study. Circulation 2010 121 14 1623 1629 10.1161/CIRCULATIONAHA.109.906958 20351236
    [Google Scholar]
  14. McKenzie J.A. Spielman L.J. Pointer C.B. Neuroinflammation as a common mechanism associated with the modifiable risk factors for Alzheimer’s and Parkinson’s diseases. Curr. Aging Sci. 2017 10 3 158 176 28302047
    [Google Scholar]
  15. Soloveva A. Fedorova D. Villevalde S. Addressing orthostatic hypotension in heart failure: Pathophysiology, clinical implications and perspectives. J. Cardiovasc. Transl. Res. 2020 13 4 549 569 10.1007/s12265‑020‑10044‑1 32748206
    [Google Scholar]
  16. Milazzo V. Di Stefano C. Milan A. Cardiovascular complications in patients with autonomic failure. Clin. Auton. Res. 2015 25 3 133 140 10.1007/s10286‑015‑0275‑0 25791260
    [Google Scholar]
  17. Maule S. Milazzo V. Maule M.M. Di Stefano C. Milan A. Veglio F. Mortality and prognosis in patients with neurogenic orthostatic hypotension. Funct. Neurol. 2012 27 2 101 106 23158582
    [Google Scholar]
  18. Hamid R. Averbeck M.A. Chiang H. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World J. Urol. 2018 36 10 1517 1527 10.1007/s00345‑018‑2301‑z 29752515
    [Google Scholar]
  19. Biaggioni I. All orthostatic hypotension is neurogenic. Clin. Auton. Res. 2023 33 4 383 386 10.1007/s10286‑023‑00966‑6 37468794
    [Google Scholar]
  20. Dani M. Taraborrelli P. Panagopoulos D. New horizons in the ageing autonomic nervous system: Orthostatic hypotension and supine hypertension. Age Ageing 2022 51 8 afac150 10.1093/ageing/afac150 35930723
    [Google Scholar]
  21. Idiaquez J.F. Idiaquez J. Casar J.C. Biaggioni I. Neurogenic orthostatic hypotension. Lessons from synucleinopathies. Am. J. Hypertens. 2021 34 2 125 133 10.1093/ajh/hpaa131 33705537
    [Google Scholar]
  22. Chen Z. Li G. Liu J. Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment. Neurobiol. Dis. 2020 134 104700 10.1016/j.nbd.2019.104700 31809788
    [Google Scholar]
  23. Fedorowski A. Ricci F. Hamrefors V. Orthostatic hypotension: Management of a complex, but common, medical problem. Circ. Arrhythm. Electrophysiol. 2022 15 3 e010573 10.1161/CIRCEP.121.010573 35212554
    [Google Scholar]
  24. Kaur R. Kumari R. Comprehensive review on hypotension: Causes, Management, and implications. Iran. J. Cardiovasc. Nurs. 2024 10 1 20 24p
    [Google Scholar]
  25. Srinivas V. Age-Related Orthostatic Hypotension: A Comprehensive Analysis of Prevalence, Mechanisms, and Management in the Geri-atric Population. Cardiology in Review 2024 10.1097/CRD.0000000000000636
    [Google Scholar]
  26. Grubb BP Kosinski DJ Kanjwal Y Orthostatic hypotension: causes, classification, and treatment. PACE 2003 2003 26 (4p1) 892 901 10.1046/j.1460‑9592.2003.t01‑1‑00155.x
    [Google Scholar]
  27. Wieling W. Kaufmann H. Claydon V.E. Diagnosis and treatment of orthostatic hypotension. Lancet Neurol. 2022 21 8 735 746 10.1016/S1474‑4422(22)00169‑7 35841911
    [Google Scholar]
  28. Ju W. Sinn D.I. Diagnosis and management of neurogenic orthostatic hypotension. Ann Clin Neurophysiol 2023 25 2 66 77 10.14253/acn.2023.25.2.66
    [Google Scholar]
  29. Palma J.A. Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov. Disord. Clin. Pract. 2017 4 3 298 308 10.1002/mdc3.12478 28713844
    [Google Scholar]
  30. Lei L.Y. Chew D.S. Raj S.R. Differential diagnosis of orthostatic hypotension. Auton. Neurosci. 2020 228 102713 10.1016/j.autneu.2020.102713 32805514
    [Google Scholar]
  31. Karim S. Chahal A. Khanji M.Y. Petersen S.E. Somers V.K. Autonomic cardiovascular control in health and disease. Compr. Physiol. 2023 13 2 4493 4511 10.1002/j.2040‑4603.2023.tb00257.x 36994768
    [Google Scholar]
  32. Saghiv M.S. Blood Pressure. Basic Exercise Physiology. Clinical and Laboratory Perspectives 2020 251 284
    [Google Scholar]
  33. Yi S. Wang L. Wang H. Ho M.S. Zhang S. Pathogenesis of α-synuclein in Parkinson’s disease: From a neuron-glia crosstalk perspective. Int. J. Mol. Sci. 2022 23 23 14753 10.3390/ijms232314753 36499080
    [Google Scholar]
  34. Sabino-Carvalho J.L. Falquetto B. Takakura A.C. Vianna L.C. Baroreflex dysfunction in Parkinson’s disease: Integration of central and peripheral mechanisms. J. Neurophysiol. 2021 125 4 1425 1439 10.1152/jn.00548.2020 33625931
    [Google Scholar]
  35. Cordonnier M. Van Nechel C. Neuro-ophthalmological emergencies: Which ocular signs or symptoms for which diseases? Acta Neurol. Belg. 2013 113 3 215 224 10.1007/s13760‑013‑0188‑4 23475430
    [Google Scholar]
  36. Jenkins D. Gregory R. Neurological Disease. Ernsting’s Aviation and Space Medicine 5E. CRC Press 2016 516 529
    [Google Scholar]
  37. Novak P. Orthostatic cerebral hypoperfusion syndrome. Front. Aging Neurosci. 2016 8 22 10.3389/fnagi.2016.00022 26909037
    [Google Scholar]
  38. Claassen J.A.H.R. Thijssen D.H.J. Panerai R.B. Faraci F.M. Regulation of cerebral blood flow in humans: Physiology and clinical implications of autoregulation. Physiol. Rev. 2021 101 4 1487 1559 10.1152/physrev.00022.2020 33769101
    [Google Scholar]
  39. Cifu D.X. Central Nervous System Disorders Affecting Mobility in Older Adults. In: Geriatric Rehabilitation 2018
    [Google Scholar]
  40. Mol A. Reijnierse E.M. Bui Hoang P.T.S. van Wezel R.J.A. Meskers C.G.M. Maier A.B. Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis. Ageing Res. Rev. 2018 48 122 144 10.1016/j.arr.2018.10.007 30394339
    [Google Scholar]
  41. Mol A. Slangen L.R.N. Trappenburg M.C. Blood pressure drop rate after standing up is associated with frailty and number of falls in geriatric outpatients. J. Am. Heart Assoc. 2020 9 7 e014688 10.1161/JAHA.119.014688 32223397
    [Google Scholar]
  42. van Twist D.J.L. Harms M.P.M. van Wijnen V.K. Diagnostic criteria for initial orthostatic hypotension: A narrative review. Clin. Auton. Res. 2021 31 6 685 698 10.1007/s10286‑021‑00833‑2 34677720
    [Google Scholar]
  43. Harms M.P.M. Colier W.N.J.M. Wieling W. Lenders J.W.M. Secher N.H. van Lieshout J.J. Orthostatic tolerance, cerebral oxygenation, and blood velocity in humans with sympathetic failure. Stroke 2000 31 7 1608 1614 10.1161/01.STR.31.7.1608 10884461
    [Google Scholar]
  44. Chobanian A.V. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003 42 6 1206 1252 10.1161/01.HYP.0000107251.49515.c2
    [Google Scholar]
  45. Campbell J.M. Klugar M. Ding S. Diagnostic test accuracy. Int. J. Evid.-Based Healthc. 2015 13 3 154 162 10.1097/XEB.0000000000000061 26355602
    [Google Scholar]
  46. Grosu C. Noea O. Maștaleru A. Ignat E.B. Leon M.M. Neurogenic orthostatic hypotension in parkinson disease—a narrative review of diagnosis and management. J. Clin. Med. 2025 14 2 630 10.3390/jcm14020630 39860637
    [Google Scholar]
  47. Wahba A. Shibao C.A. Muldowney J.A.S. Peltier A. Habermann R. Biaggioni I. Management of orthostatic hypotension in the hospitalized patient: A narrative review. Am. J. Med. 2022 135 1 24 31 10.1016/j.amjmed.2021.07.030 34416163
    [Google Scholar]
  48. Fanciulli A. Leys F. Falup-Pecurariu C. Thijs R. Wenning G.K. Management of orthostatic hypotension in Parkinson’s disease. J. Parkinsons Dis. 2020 10 s1 S57 S64 10.3233/JPD‑202036 32716319
    [Google Scholar]
  49. Westfall T.C. Westfall D.P. Adrenergic agonists and antagonists. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. In: Brunton LL, Lazo JS, Parker KL, Eds 11th ed Brunton L.L. Lazo J.S. Parker K.L. New York McGraw-Hill 2006 237 315
    [Google Scholar]
  50. Mozaffari S. Mousavi T. Nikfar S. Abdollahi M. Common gastrointestinal drug-drug interactions in geriatrics and the importance of careful planning. Expert Opin. Drug Metab. Toxicol. 2023 19 11 807 828 10.1080/17425255.2023.2273384 37862038
    [Google Scholar]
  51. Shah R.R. Drug development and use in the elderly: Search for the right dose and dosing regimen. Br. J. Clin. Pharmacol. 2004 58 5 452 469 10.1111/j.1365‑2125.2004.02228.x 15521892
    [Google Scholar]
  52. Juraschek S.P. Simpson L.M. Davis B.R. Beach J.L. Ishak A. Mukamal K.J. Effects of antihypertensive class on falls, syncope, and orthostatic hypotension in older adults: The ALLHAT trial. Hypertension 2019 74 4 1033 1040 10.1161/HYPERTENSIONAHA.119.13445 31476905
    [Google Scholar]
  53. Verwoert G.C. Mattace-Raso F.U.S. Hofman A. Orthostatic hypotension and risk of cardiovascular disease in elderly people: The Rotterdam study. J. Am. Geriatr. Soc. 2008 56 10 1816 1820 10.1111/j.1532‑5415.2008.01946.x 18795982
    [Google Scholar]
  54. Wehling M. Morbus diureticus in the elderly: epidemic overuse of a widely applied group of drugs. J. Am. Med. Dir. Assoc. 2013 14 6 437 442 10.1016/j.jamda.2013.02.002 23510827
    [Google Scholar]
  55. Friedman-Jakubovics M. Fazylov R. Diuretics. In:Side Effects of Drugs Annual. Elsevier 2019 227 236
    [Google Scholar]
  56. Henry D.A. Hyponatremia. Ann. Intern. Med. 2015 163 3 ITC1 ITC16 10.7326/AITC201508040 26237763
    [Google Scholar]
  57. Joseph A Wanono R Flamant M Vidal-Petiot E. Orthostatic hypotension: A review. Nephrol Ther 2017 S55 -67 (Suppl.1) 10.1016/j.nephro.2017.01.003 28577744
    [Google Scholar]
  58. Filippatos T.D. Makri A. Elisaf M.S. Liamis G. Hyponatremia in the elderly: Challenges and solutions. Clin. Interv. Aging 2017 12 1957 1965 10.2147/CIA.S138535 29180859
    [Google Scholar]
  59. Siragy H.M. Hyponatremia, fluid-electrolyte disorders, and the syndrome of inappropriate antidiuretic hormone secretion: diagnosis and treatment options. Endocr. Pract. 2006 12 4 446 457 10.4158/EP.12.4.446 16901803
    [Google Scholar]
  60. Tamargo J. Segura J. Ruilope L.M. Diuretics in the treatment of hypertension. Part 1: Thiazide and thiazide-like diuretics. Expert Opin. Pharmacother. 2014 15 4 527 547 10.1517/14656566.2014.879118 24444254
    [Google Scholar]
  61. Ellison D.H. Clinical pharmacology in diuretic use. Clin. J. Am. Soc. Nephrol. 2019 14 8 1248 1257 10.2215/CJN.09630818 30936153
    [Google Scholar]
  62. Hix J.K. Silver S. Sterns R.H. Diuretic-associated hyponatremia. In:Seminars in nephrology. Elsevier 2011 10.1016/j.semnephrol.2011.09.010
    [Google Scholar]
  63. Opie L.H. Gersh B. Calcium channel blockers. Drugs for the Heart 2013 8 64 92 10.1016/B978‑1‑4557‑3322‑4.00012‑0
    [Google Scholar]
  64. Butler J.M. Begg E.J. Free drug metabolic clearance in elderly people. Clin. Pharmacokinet. 2008 47 5 297 321 10.2165/00003088‑200847050‑00002 18399712
    [Google Scholar]
  65. Höcht C. Bertera F.M. Mayer M.A. Taira C.A. Issues in drug metabolism of major antihypertensive drugs: β-blockers, calcium channel antagonists and angiotensin receptor blockers. Expert Opin. Drug Metab. Toxicol. 2010 6 2 199 211 10.1517/17425250903397381 20095790
    [Google Scholar]
  66. Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab. Rev. 2009 41 2 67 76 10.1080/03602530902722679 19514965
    [Google Scholar]
  67. Sultan S. Heis Z. Jahangir A. Drug–nutrient interactions in the elderly. In:Molecular Basis of Nutrition and Aging. Elsevier 2016 73 107 10.1016/B978‑0‑12‑801816‑3.00007‑8
    [Google Scholar]
  68. Shibao C. Lipsitz L.A. Biaggioni I. Evaluation and treatment of orthostatic hypotension. J. Am. Soc. Hypertens. 2013 7 4 317 324 10.1016/j.jash.2013.04.006 23721882
    [Google Scholar]
  69. Williams B.R. Kim J. Cardiovascular drug therapy in the elderly: theoretical and practical considerations. Drugs Aging 2003 20 6 445 463 10.2165/00002512‑200320060‑00004 12710864
    [Google Scholar]
  70. Salhanick S.D. Shannon M.W. Management of calcium channel antagonist overdose. Drug Saf. 2003 26 2 65 79 10.2165/00002018‑200326020‑00001 12534324
    [Google Scholar]
  71. Clifford C. Sethi M. Cox D. Manini A.F. First-line vasopressor and mortality rates in ED patients with acute drug overdose. J. Med. Toxicol. 2021 17 1 1 9 10.1007/s13181‑020‑00797‑1 32656625
    [Google Scholar]
  72. Caballero-Gonzalez J. Calcium channel blockers in the management of hypertension in the elderly. 2014 12 (3) 160 -5
  73. Pereira J.M. Paiva J.A. Antimicrobial drug interactions in the critically ill patients. Curr. Clin. Pharmacol. 2013 8 1 25 38 22946870
    [Google Scholar]
  74. Wang Z. Yang B. Polypharmacology in Clinical Applications: Cardiovascular Polypharmacology. In:Polypharmacology: Principles and Methodologies. Springer 2022 133 198 10.1007/978‑3‑031‑04998‑9_4
    [Google Scholar]
  75. Ferrara N. Komici K. Corbi G. β-adrenergic receptor responsiveness in aging heart and clinical implications. Front. Physiol. 2014 4 396 10.3389/fphys.2013.00396 24409150
    [Google Scholar]
  76. Ziff O.J. Samra M. Howard J.P. Beta-blocker efficacy across different cardiovascular indications: An umbrella review and meta-analytic assessment. BMC Med. 2020 18 1 103 10.1186/s12916‑020‑01564‑3 32366251
    [Google Scholar]
  77. Shao C. Coronary artery disease: From mechanism to clinical practice. Adv. Exp. Med. Biol. 2020 1177 1 36 10.1007/978‑981‑15‑2517‑9_1
    [Google Scholar]
  78. Matera M.G. Rogliani P. Calzetta L. Cazzola M. An overview of the efficacy and safety of β2-adrenoceptor antagonists for the treatment of chronic obstructive pulmonary disease. Expert Opin. Drug Saf. 2024 23 7 833 844 10.1080/14740338.2024.2362817
    [Google Scholar]
  79. Čižmáriková R. Habala L. Valentová J. Markuliak M. Survey of pharmacological activity and pharmacokinetics of selected β-adrenergic blockers in regard to their stereochemistry. Appl. Sci. (Basel) 2019 9 4 625 10.3390/app9040625
    [Google Scholar]
  80. Opie L. β-blocking agents. In: Drugs for the Heart. Saunders 1980 10.1016/S0140‑6736(80)90479‑1
    [Google Scholar]
  81. Martínez-Milla J. García M.C. Palfy J.A. Urquía MT Castillo ML Arbiol AD Mariscal ML Jiménez-Varas I Figuero SB Franco-Pelaéz JA Beta-blocker therapy in elderly patients with renal dysfunction and heart failure. Journal of Geriatric Cardiology: JGC 28 01 2021 18 1 20 [https://doi.org/10.11909/j.issn.1671-5411.2021.01.005
    [Google Scholar]
  82. Khan Z. Demirtaş E. Kıroğlu O. Karataş Y. Beta-Adrenergic Blockers’ Supportive and Adverse Role in Hypertension: A Review of Three Generations: Beta-adrenergic blockers role in hypertension. Pakistan Journal of Medicine and Dentistry. 2022 11 1 63 71 [https://doi.org/10.36283/PJMD11-1/011
    [Google Scholar]
  83. Mangoni A.A. Jackson S.H.D. The implications of a growing evidence base for drug use in elderly patients Part 2 − ACE inhibitors and angiotensin receptor blockers in heart failure and high cardiovascular risk patients. Br. J. Clin. Pharmacol. 2006 61 5 502 512 10.1111/j.1365‑2125.2006.02610.x 16669842
    [Google Scholar]
  84. Spinar J. Vitovec J. Pluhacek L. Spinarova L. Fischerova B. Toman J. First dose hypotension after angiotensin converting enzyme inhibitor captopril and angiotensin II blocker losartan in patients with acute myocardial infarction. Int. J. Cardiol. 2000 75 2-3 197 204 10.1016/S0167‑5273(00)00323‑5 11077134
    [Google Scholar]
  85. Liamis G. Milionis H. Elisaf M. Blood pressure drug therapy and electrolyte disturbances. Int. J. Clin. Pract. 2008 62 10 1572 1580 10.1111/j.1742‑1241.2008.01860.x 18822027
    [Google Scholar]
  86. Vegter S. Perna A. Postma M.J. Navis G. Remuzzi G. Ruggenenti P. Sodium intake, ACE inhibition, and progression to ESRD. J. Am. Soc. Nephrol. 2012 23 1 165 173 10.1681/ASN.2011040430 22135311
    [Google Scholar]
  87. Palma J-A. Kaufmann H. Clinical trials for neurogenic orthostatic hypotension: a comprehensive review of endpoints, pitfalls, and challenges. Semin. Neurol. 2020 40 5 523 539 10.1055/s‑0040‑1713846
    [Google Scholar]
  88. Agewall S. Cardiovascular pharmacotherapyEuropean Heart Jour-nal – Cardiovascular Pharmacotherapy 2018 1-1 10.1093/ehjcvp/pvz008
  89. Anuduang A. Mustapha W.A.W. Lim S.J. Evaluation of Thai silkworm (Bombyx mori L.) hydrolysate powder for blood pressure reduction in hypertensive rats. Foods 2024 13 6 943 10.3390/foods13060943 38540933
    [Google Scholar]
  90. Shoda J. Kanno Y. Suzuki H. A five-year comparison of the renal protective effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with non-diabetic nephropathy. Intern. Med. 2006 45 4 193 198 10.2169/internalmedicine.45.1515 16543688
    [Google Scholar]
  91. Raveh D. Kopyt M. Hite Y. Rudensky B. Sonnenblick M. Yinnon A.M. Risk factors for nephrotoxicity in elderly patients receiving once-daily aminoglycosides. QJM 2002 95 5 291 297 10.1093/qjmed/95.5.291 11978900
    [Google Scholar]
  92. Garasto S. Fusco S. Corica F. Estimating glomerular filtration rate in older people. BioMed Res. Int. 2014 2014 1 1 12 10.1155/2014/916542 24772439
    [Google Scholar]
  93. Curran M.P. McCormack P.L. Simpson D. Perindopril. Drugs 2006 66 2 235 255 10.2165/00003495‑200666020‑00010 16451098
    [Google Scholar]
  94. Milazzo V. Drugs and orthostatic hypotension: Evidence from liter-ature. J Hypertens Open Access (104) 1 10.4172/2167‑1095.1000104
    [Google Scholar]
  95. Mosnaim A.D. Abiola R. Wolf M.E. Perlmuter L.C. Etiology and risk factors for developing orthostatic hypotension. Am. J. Ther. 2010 17 1 86 91 10.1097/MJT.0b013e3181a2b1bb 19433976
    [Google Scholar]
  96. Lundberg J.O. Weitzberg E. NO generation from nitrite and its role in vascular control. Arterioscler. Thromb. Vasc. Biol. 2005 25 5 915 922 10.1161/01.ATV.0000161048.72004.c2 15746440
    [Google Scholar]
  97. Gupta V. Lipsitz L.A. Orthostatic hypotension in the elderly: diagnosis and treatment. Am. J. Med. 2007 120 10 841 847 10.1016/j.amjmed.2007.02.023 17904451
    [Google Scholar]
  98. Thatcher G.R.J. Nicolescu A.C. Bennett B.M. Toader V. Nitrates and no release: contemporary aspects in biological and medicinal chemistry. Free Radic. Biol. Med. 2004 37 8 1122 1143 10.1016/j.freeradbiomed.2004.06.013 15451053
    [Google Scholar]
  99. Bahadoran Z. Potential Applications of Nitric Oxide Donors in Type 2 Diabetes In: The Role of Nitric Oxide in Type 2 Diabetes 2022 324 10.2174/9789815079814122010018
    [Google Scholar]
  100. Fitzgibbon-Collins L. Cerebrovascular hemodynamics, gait, and falls in an elderly population. MOBILIZE Boston StudyNeurology 2018 74 20 1627 1633 10.1212/WNL.0b013e3181df0982
    [Google Scholar]
  101. Medow M.S. Stewart J.M. Sanyal S. Mumtaz A. Sica D. Frishman W.H. Pathophysiology, diagnosis, and treatment of orthostatic hypotension and vasovagal syncope. Cardiol. Rev. 2008 16 1 4 20 10.1097/CRD.0b013e31815c8032 18091397
    [Google Scholar]
  102. Kumar S. Goyal L. Singh S. Tremor and rigidity in patients with Parkinson’s disease: emphasis on epidemiology, pathophysiology and contributing factors. CNS Neurological Disorders- Drug Targets. 2022 01 Aug 21 7 596 609 [https://doi.org/10.2174/1871527320666211006142100
    [Google Scholar]
  103. Klietz M. Greten S. Wegner F. Höglinger G.U. Safety and tolerability of pharmacotherapies for Parkinson’s disease in geriatric patients. Drugs Aging 2019 36 6 511 530 10.1007/s40266‑019‑00654‑z 30937878
    [Google Scholar]
  104. Camargo C.H.F. Orthostatic hypotension and its relationship to the clinical course of patients with Parkinson’s disease. J. Alzheimers Dis. Parkinsonism 2014 4 155
    [Google Scholar]
  105. Pérez-Lloret S. Quarracino C. Otero-Losada M. Rascol O. Droxidopa for the treatment of neurogenic orthostatic hypotension in neurodegenerative diseases. Expert Opin. Pharmacother. 2019 20 6 635 645 10.1080/14656566.2019.1574746 30730771
    [Google Scholar]
  106. Liu X. Hepatic metabolism in liver health and disease. Liver Pathophysiology. Elsevier 2017 391 400 10.1016/B978‑0‑12‑804274‑8.00030‑8
    [Google Scholar]
  107. Mouchaileh N. Hughes A.J. Pharmacological management of Parkinson’s disease in older people. J. Pharm. Pract. Res. 2020 50 5 445 454 10.1002/jppr.1683
    [Google Scholar]
  108. van Rumund A. Pavelka L. Esselink R.A.J. Peripheral decarboxylase inhibitors paradoxically induce aromatic L-amino acid decarboxylase. NPJ Parkinsons Dis. 2021 7 1 29 10.1038/s41531‑021‑00172‑z 33741988
    [Google Scholar]
  109. LeWitt P.A. Kymes S. Hauser R.A. Parkinson disease and orthostatic hypotension in the elderly: Recognition and management of risk factors for falls. Aging Dis. 2020 11 3 679 691 10.14336/AD.2019.0805 32489712
    [Google Scholar]
  110. Minicuci N. Maggi S. Pavan M. Enzi G. Crepaldi G. Prevalence rate and correlates of depressive symptoms in older individuals: the Veneto Study. J. Gerontol. A Biol. Sci. Med. Sci. 2002 57 3 M155 M161 10.1093/gerona/57.3.M155 11867651
    [Google Scholar]
  111. Palazidou E. Traditional and novel possible targets for antidepressant drugs. Herbal Medicine in Depression: Traditional Medicine to Innovative Drug Delivery. Springer 2016 43 73 10.1007/978‑3‑319‑14021‑6_2
    [Google Scholar]
  112. Zhou D. Guo J. Linnenbach A.J. Booth-Genthe C.L. Grimm S.W. Role of human UGT2B10 in N-glucuronidation of tricyclic antidepressants, amitriptyline, imipramine, clomipramine, and trimipramine. Drug Metab. Dispos. 2010 38 5 863 870 10.1124/dmd.109.030981 20133892
    [Google Scholar]
  113. Bobo W.V. Richelson E. Monoamine oxidase inhibitors for treatment-resistant depressionManaging Treatment-Resistant Depression. Academic Press 2022 137 166 10.1016/B978‑0‑12‑824067‑0.00009‑8
    [Google Scholar]
  114. Shulman K.I. Herrmann N. Walker S.E. Current place of monoamine oxidase inhibitors in the treatment of depression. CNS Drugs 2013 27 10 789 797 10.1007/s40263‑013‑0097‑3 23934742
    [Google Scholar]
  115. Eschlböck S. Wenning G. Fanciulli A. Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms. J. Neural Transm. (Vienna) 2017 124 12 1567 1605 10.1007/s00702‑017‑1791‑y 29058089
    [Google Scholar]
  116. Stroup T.S. Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry 2018 17 3 341 356 10.1002/wps.20567 30192094
    [Google Scholar]
  117. Shi S. Klotz U. Age-related changes in pharmacokinetics. Curr. Drug Metab. 2011 12 7 601 610 10.2174/138920011796504527 21495970
    [Google Scholar]
  118. Arana GW An overview of side effects caused by typical antipsy-chotics. 2000 J Clin Psychiatry 61 (4) 5 11 (Suppl.8) 10811237
    [Google Scholar]
  119. Levine M. Ruha A.M. Overdose of atypical antipsychotics: clinical presentation, mechanisms of toxicity and management. CNS Drugs 2012 26 7 601 611 10.2165/11631640‑000000000‑00000 22668123
    [Google Scholar]
  120. Ullah R. Drugs Resistance in Heart Diseases. Biochemistry of Drug Resistance. Cham Springer 2021 295
    [Google Scholar]
  121. Patra S. Insights into the mode of action of antianginal and vasodilating agents. How synthetic drugs work. Elsevier 2023 329 348 10.1016/B978‑0‑323‑99855‑0.00014‑2
    [Google Scholar]
  122. Kadioglu S.B. Celik T. Orthostatic hypotension and drugs: drug-induced orthostatic hypotension. Orthostatic Hypotension in Older Adults. Springer 2020 45 59
    [Google Scholar]
  123. Corsonello A. Pedone C. Incalzi R. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr. Med. Chem. 2010 17 6 571 584 10.2174/092986710790416326 20015034
    [Google Scholar]
  124. Panel A.G.S.B.C.U.E. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc. 2012 60 4 616 631 10.1111/j.1532‑5415.2012.03923.x 22376048
    [Google Scholar]
  125. Starcevic V. Discontinuation of Psychotropic Medications. Pocket Guide to Emergent and Serious Adverse Events in Psychopharmacology 2023 51 10.1176/appi.books.9781615379903.lg
    [Google Scholar]
  126. O’Flynn A.M. Curtin R.J. Perry I.J. Kearney P.M. Hypertension prevalence, awareness, treatment, and control: should 24‐hour ambulatory blood pressure monitoring be the tool of choice? J. Clin. Hypertens. 2016 18 7 697 702 10.1111/jch.12737 26611695
    [Google Scholar]
  127. Ahmed S. Ibrahim U. A compendium of pathophysiologic basis of etiologic risk factors for painful vaso-occlusive crisis in sickle cell disease. Niger J Basic Clin Sci 2017 14 2 57 77 10.4103/njbcs.njbcs_11_17
    [Google Scholar]
  128. Kim M.J. Farrell J. Orthostatic hypotension: A practical approach. Am. Fam. Physician 2022 105 1 39 49 35029940
    [Google Scholar]
  129. Kligler B Bair MJ Banerjea R Clinical policy recommenda-tions from the VHA state-of-the-art conference on non-pharmacolog-ical approaches to chronic musculoskeletal pain J Gen Intern Med 2018 33 (S1) 16 23 (Suppl.1) 10.1007/s11606‑018‑4323‑z 29633133
    [Google Scholar]
  130. Davies M.J. D’Alessio D.A. Fradkin J. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018 41 12 2669 2701 10.2337/dci18‑0033 30291106
    [Google Scholar]
  131. Shibao C.A. Biaggioni I. Management of orthostatic hypotension, postprandial hypotension, and supine hypertension. Seminars in Neurology. Thieme Medical Publishers 2020 10.1055/s‑0040‑1713886
    [Google Scholar]
  132. Mills P.B. Nonpharmacologic management of orthostatic hypotension: a systematic review. Arch. Phys. Med. Rehabil. 2015 96 2 366 375.e6 10.1016/j.apmr.2014.09.028
    [Google Scholar]
  133. Leggio M. Fusco A. Limongelli G. Sgorbini L. Exercise training in patients with pulmonary and systemic hypertension: A unique therapy for two different diseases. Eur. J. Intern. Med. 2018 47 17 24 10.1016/j.ejim.2017.09.010 28911936
    [Google Scholar]
  134. Baldwin M.D. The primary care physician/nephrologist partnership in treating chronic kidney disease. Prim. Care 2014 41 4 837 856 10.1016/j.pop.2014.08.004 25439537
    [Google Scholar]
  135. Lahrmann H. Cortelli P. Hilz M. Mathias C.J. Struhal W. Tassinari M. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur. J. Neurol. 2006 13 9 930 936 10.1111/j.1468‑1331.2006.01512.x 16930356
    [Google Scholar]
  136. Garland E.M. Gamboa A. Nwazue V.C. Effect of high dietary sodium intake in patients with postural tachycardia syndrome. J. Am. Coll. Cardiol. 2021 77 17 2174 2184 10.1016/j.jacc.2021.03.005 33926653
    [Google Scholar]
  137. Perez L.M. Dietary interventions and strategies to reduce sodium consumption and volume overload in hemodialysis patients. Dissertation 2021
    [Google Scholar]
  138. Rissardo J.P. The intersection of autonomic dysfunction and parkinson’s disease: Insights into neurogenic and classical orthostatic hypotension. Cureus 2025 17 7 e88487 10.7759/cureus.88487
    [Google Scholar]
  139. Wieling W. van Dijk N. Thijs R.D. de Lange F.J. Krediet C.T.P. Halliwill J.R. Physical countermeasures to increase orthostatic tolerance. J. Intern. Med. 2015 277 1 69 82 10.1111/joim.12249 24697914
    [Google Scholar]
  140. Rabe E. Partsch H. Hafner J. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology 2018 33 3 163 184 10.1177/0268355516689631 28549402
    [Google Scholar]
  141. Arbique D. Cheek D. Welliver M. Vongpatanasin W. Management of neurogenic orthostatic hypotension. J. Am. Med. Dir. Assoc. 2014 15 4 234 239 10.1016/j.jamda.2013.10.014 24388946
    [Google Scholar]
  142. Freeman R. Abuzinadah A.R. Gibbons C. Jones P. Miglis M.G. Sinn D.I. Orthostatic Hypotension. J. Am. Coll. Cardiol. 2018 72 11 1294 1309 10.1016/j.jacc.2018.05.079 30190008
    [Google Scholar]
  143. Skylynn T. Abel T. Christopher L. Benefits and risks of medications used in the management of hypotension: a review. Cureus 2024 16 1 e51608 10.7759/cureus.51608 38313995
    [Google Scholar]
  144. Alomar M.J. Factors affecting the development of adverse drug reactions (Review article). Saudi Pharm. J. 2014 22 2 83 94 10.1016/j.jsps.2013.02.003 24648818
    [Google Scholar]
  145. Löscher W. Klein P. The pharmacology and clinical efficacy of antiseizure medications: from bromide salts to cenobamate and beyond. CNS Drugs 2021 35 9 935 963 10.1007/s40263‑021‑00827‑8 34145528
    [Google Scholar]
  146. Ko H-Y. Blood Pressure Stabilization in Spinal Cord Injuries: A Focus on Orthostatic Hypotension and Supine Hypertension. A Practical Guide to Care of Spinal Cord Injuries: Clinical Questions and Answers. Springer 2023 447 465 10.1007/978‑981‑99‑4542‑9_24
    [Google Scholar]
  147. Smith W. Wan H. Much D. Robinson A.G. Martin P. Clinical benefit of midodrine hydrochloride in symptomatic orthostatic hypotension: A phase 4, double-blind, placebo-controlled, randomized, tilt-table study. Clin. Auton. Res. 2016 26 4 269 277 10.1007/s10286‑016‑0363‑9 27372462
    [Google Scholar]
  148. Hardy J. Haywood A. Gogna G. Oral medicinal cannabinoids to relieve symptom burden in the palliative care of patients with advanced cancer: a double-blind, placebo-controlled, randomised clinical trial of efficacy and safety of 1:1 delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Trials 2020 21 1 611 10.1186/s13063‑020‑04541‑6 32631447
    [Google Scholar]
  149. Kalra D.K. Raina A. Sohal S. Neurogenic orthostatic hypotension: state of the art and therapeutic strategies. Clin. Med. Insights Cardiol. 2020 ••• 14 10.1177/1179546820953415 32943966
    [Google Scholar]
  150. Keating G.M. Droxidopa: A review of its use in symptomatic neurogenic orthostatic hypotension. Drugs 2015 75 2 197 206 10.1007/s40265‑014‑0342‑1 25559422
    [Google Scholar]
  151. Katsi V. Papakonstantinou I. Solomou E. Antonopoulos A.S. Vlachopoulos C. Tsioufis K. Management of hypertension and blood pressure dysregulation in patients with parkinson’s disease—a systematic review. Curr. Hypertens. Rep. 2021 23 5 26 10.1007/s11906‑021‑01146‑5 33961147
    [Google Scholar]
  152. Cannom D.S. Management of coexistent neurogenic orthostatic hypotension and supine hypertension. J. Clin. Hypertens. 2019 21 11 1732 1734 10.1111/jch.13699 31599484
    [Google Scholar]
  153. Lamotte G. Holmes C. Sullivan P. Goldstein D.S. Substantial renal conversion of l-threo-3,4-dihydroxyphenylserine (droxidopa) to norepinephrine in patients with neurogenic orthostatic hypotension. Clin. Auton. Res. 2019 29 1 113 117 10.1007/s10286‑018‑0564‑5 30229336
    [Google Scholar]
  154. Krittanawong C. Misconceptions K.C. Facts A.O.H. bout Orthostatic Hypo-tension Am. J. Med. 2024 39370032
    [Google Scholar]
  155. Scorr L.M. Factor S.A. VMAT2 inhibitors for the treatment of tardive dyskinesia. J. Neurol. Sci. 2018 389 43 47 10.1016/j.jns.2018.02.006 29433808
    [Google Scholar]
  156. Veazie S. Fludrocortisone for orthostatic hypotension. Cochrane Database Syst. Rev. 2021 5 CD012868 10.1002/14651858.CD012868.pub2
    [Google Scholar]
  157. Núñez J. Bayés-Genís A. Zannad F. Long-term potassium monitoring and dynamics in heart failure and risk of mortality. Circulation 2018 137 13 1320 1330 10.1161/CIRCULATIONAHA.117.030576 29025765
    [Google Scholar]
  158. McKinley R.L. Marijuana, a Journey through the Endocannabinoid System: Unmasking the Paradoxical Effect – Part 2. In: Badria F A, Ed. Phenolic Compounds: Chemistry, Synthesis, Diversity, Non-Conventional Industrial, Pharmaceutical and Therapeutic Ap-plications IntechOpen 2022 10.5772/intechopen.101556
    [Google Scholar]
  159. Myint N. A case of severe advanced diabetic cardiac autonomic neuropathy: Severe orthostatic hypotension complicated with episodes of nocturnal supine hypertensive emergency episodes. Cureus 2024 16 12 e75153 10.7759/cureus.75153 39759607
    [Google Scholar]
  160. Bencze M. Boroš A. Behuliak M. Vavřínová A. Vaněčková I. Zicha J. Changes in cardiovascular autonomic control induced by chronic inhibition of acetylcholinesterase during pyridostigmine or donepezil treatment of spontaneously hypertensive rats. Eur. J. Pharmacol. 2024 971 176526 10.1016/j.ejphar.2024.176526 38537804
    [Google Scholar]
  161. Chen J.J. Han Y. Tang J. Portillo I. Hauser R.A. Dashtipour K. Standing and supine blood pressure outcomes associated with droxidopa and midodrine in patients with neurogenic orthostatic hypotension: A Bayesian meta-analysis and mixed treatment comparison of randomized trials. Ann. Pharmacother. 2018 52 12 1182 1194 10.1177/1060028018786954 29972032
    [Google Scholar]
  162. Jones P.K. Shaw B.H. Raj S.R. Orthostatic hypotension: Managing a difficult problem. Expert Rev. Cardiovasc. Ther. 2015 13 11 1263 1276 10.1586/14779072.2015.1095090 26427904
    [Google Scholar]
  163. Rastogi R. Meek B.D. Management of chronic pain in elderly, frail patients: Finding a suitable, personalized method of control. Clin. Interv. Aging 2013 8 37 46 10.2147/CIA.S30165 23355774
    [Google Scholar]
  164. Hale G.M. Valdes J. Brenner M. The treatment of primary orthostatic hypotension. Ann. Pharmacother. 2017 51 5 417 428 10.1177/1060028016689264 28092986
    [Google Scholar]
  165. Hoel R.W. Connolly R.M.G. Takahashi P.Y. Polypharmacy management in older patients. Mayo Clinic Proceedings 2021 96 1 242 256 10.1016/j.mayocp.2020.06.012
    [Google Scholar]
  166. DePace N.L. Oral vasoactive medications: A summary of midodrine and droxidopa as applied to orthostatic dysfunction. Cardio Open 2022 7 1 225 241
    [Google Scholar]
  167. Vongchaiudomchoke T. Siriyong P. Wachiraphansakul N. Noppakun K. Effect of fludrocortisone on intradialytic hypotension: An open-label, randomized, crossover study. Blood Purif. 2023 52 3 264 274 10.1159/000527608 36473430
    [Google Scholar]
  168. Isaacson S. Shill H.A. Vernino S. Ziemann A. Rowse G.J. Safety and durability of effect with long-term, open-label droxidopa treatment in patients with symptomatic neurogenic orthostatic hypotension (NOH303). J. Parkinsons Dis. 2016 6 4 751 759 10.3233/JPD‑160860 27636856
    [Google Scholar]
  169. Singer W. Sandroni P. Opfer-Gehrking T.L. Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Arch. Neurol. 2006 63 4 513 518 10.1001/archneur.63.4.noc50340 16476804
    [Google Scholar]
/content/journals/chyr/10.2174/0115734021380889250919160828
Loading
Orthostatic Hypotension in Older Adults: A Narrative Review of Causes, Drug Impacts, and Management Strategies
Bentham Science Publishers ; https://doi.org/10.2174/0115734021380889250919160828
/content/journals/chyr/10.2174/0115734021380889250919160828
/content/journals/chyr/10.2174/0115734021380889250919160828
Loading

Data & Media loading...


  • Article Type:     Review Article
Keywords: ace ; heart rate ; diuretics ; blood pressure ; β -β-blocker ; inhibitors. ; calcium channel blocker ; Orthostatic hypotension

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test