Management of Orthostatic Hypotension

Initial Assessment

The European Society of Cardiology recommends verifying orthostatic hypotension testing technique, measuring blood pressure after 5 minutes of rest in sitting/lying position, followed by measurements at 1 minute and 3 minutes after standing 3
Review of current medications that may worsen orthostatic symptoms, including antihypertensives, alpha-blockers, sedatives, and certain psychotropic medications, is suggested by the European Heart Journal 2

The European Heart Journal suggests increasing fluid intake to 2-3 liters per day and salt intake to approximately 10g of NaCl daily, unless contraindicated by other conditions, to help manage orthostatic hypotension 4
Rapid cool water ingestion is recommended by the European Heart Journal to combat orthostatic intolerance 4
Sleeping with the head of the bed elevated (10°) is advised by the European Heart Journal to prevent nocturnal polyuria and maintain better fluid distribution 4
The European Heart Journal recommends using compression stockings or abdominal binders to reduce gravitational venous pooling 4, 5
Teaching physical counter-pressure maneuvers, such as leg crossing and squatting, is suggested by the European Heart Journal to perform when experiencing prodromal symptoms 4, 5

The European Heart Journal recommends considering switching to alternative therapies rather than simply reducing doses if the patient is taking medications that worsen orthostatic hypotension 2
Avoiding beta-blockers when possible is suggested by the European Heart Journal, as they can exacerbate symptoms in patients with sick sinus syndrome and pacemakers 2

Referral to Neurology is recommended by the European Heart Journal if symptoms suggest possible autonomic dysfunction beyond what would be expected with sick sinus syndrome 4, 5
The European Heart Journal suggests referral to Physical therapy for guidance on physical counter-maneuvers and reconditioning exercises 4

Regular monitoring of orthostatic vital signs to assess treatment efficacy is recommended by Praxis Medical Insights 3
Assessing for symptom improvement using standardized measures of orthostatic intolerance is suggested by the European Heart Journal 5

The European Heart Journal recommends avoiding treating isolated supine hypertension aggressively, as this may worsen orthostatic symptoms 2
Recognizing that orthostatic symptoms despite normal blood pressure measurements may indicate postural orthostatic tachycardia syndrome (POTS) or other forms of orthostatic intolerance is suggested by the European Heart Journal 5, 6