Orthostatic hypotension in older adults. The Cardiovascular Health Study. Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med. Hollister AS. Orthostatic hypotension. Causes, evaluation, and management. West J Med. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur J Neurol. Freeman R. Am Fam Physician.
Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. Practice of Geriatrics. Philadelphia, Pa. Clinical indicators of dehydration severity in elderly patients. J Emerg Med. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Carlson JE. Assessment of orthostatic blood pressure: measurement technique and clinical applications.
South Med J. Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension. Lamarre-Cliche M, Cusson J. The fainting patient: value of the head-upright tilt-table test in adult patients with orthostatic intolerance.
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J Am Coll Cardiol. Bradley WG. Neurology in Clinical Practice. Fludrocortisone in the treatment of hypotensive disorders in the elderly [published correction appears in Heart.
A double-blind, dose-response study of midodrine in neurogenic ortho-static hypotension. Food and Drug Administration. Drug safety and availability. Midodrine update. September Accessed January 3, Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Therapeutic experience with fludrocortisone in diabetic postural hypotension. Br Med J. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Screening for Developmental Delay. Sep 1, Issue. Evaluation and Management of Orthostatic Hypotension. C 6 , 14 Patients with chronic orthostatic hypotension should be counseled to avoid large carbohydrate-rich meals, limit alcohol intake, and ensure adequate hydration. C 6 , 22 Fludrocortisone, midodrine, and pyridostigmine Mestinon are effective therapies for chronic orthostatic hypotension.
Enlarge Print Table 1. Table 1. Enlarge Print Table 2. Table 2. Enlarge Print Table 3. Physical Examination Clues to Diagnosis of Orthostatic Hypotension Examination findings Possible diagnosis Comments Aphasia, dysarthria, facial droop, hemiparesis Stroke — Cardiac murmur or gallop Congestive heart failure, myocardial infarction — Cogwheel rigidity, festinating gait, lack of truncal rotation while turning, masked facies Parkinson disease — Confusion, dry mucous membranes, dry tongue, longitudinal tongue furrows, speech difficulty, sunken eyes, upper body weakness Dehydration in older patients Study of 55 patients 61 to 98 years of age in emergency care setting found these findings highly reliable 12 Decreased libido, impotence in men; urinary retention and incontinence in women Pure autonomic failure 12 — Dependent lower extremity edema, stasis dermatitis Right-sided congestive heart failure, venous insufficiency — Information from references 11 and Table 3.
Enlarge Print Table 4. Indications and Procedure for Head-Up Tilt-Table Testing Indications High probability of orthostatic hypotension despite an initial negative evaluation e. Table 4. Enlarge Print Figure 1. Patient undergoing head-up tilt-table testing. Figure 1. Enlarge Print Table 5. Gwen Windham and Michael E. The authors thank the staff and participants of the ARIC study for their important contributions.
Lauren Nelson laurennelson jhmi. Contact us or find a patient care location. Privacy Statement. Non-Discrimination Notice. All rights reserved. Skip Navigation. I Want To I Want to Find Research Faculty Enter the last name, specialty or keyword for your search below. Assess by verbal report and observation the patient's ability to stand.
Have patient lie in bed with the head flat for a minimum of 3 minutes, and preferably 5 minutes. Measure the blood pressure and the pulse while the patient is supine. Instruct patient to sit for 1 minute. Ask patient about dizziness, weakness, or visual changes associated with position change. Note diaphoresis or pallor. Check sitting blood pressure and pulse. Instruct patient to stand. If patient is unable to stand, sit patient upright with legs dangling over the edge of the bed.
The patient should be permitted to resume a supine position immediately if syncope or near syncope develops. Measure the blood pressure and pulse immediately after patient has stood up, and then repeat the measurements 3 minutes after patient stands.
Support the forearm at heart level when taking the blood pressures to prevent inaccurate measurement. Assist patient back to bed in a position of comfort. Document vital signs and other pertinent observations on the nursing flowsheet or in the medical record. Note all measurements taken and the position of the patient during each reading. Poughkeepsie, New York. Academic Pediatric Urologists. New York. New Jersey Nephrologist Needed. New Jersey. Palliative Care.
Palliative Care Physician.
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