How to Approach and Manage Orthostatic Hypotension

Orthostatic hypotension (OH) is a frequently undiagnosed condition, particularly affecting older adults and individuals with autonomic dysfunction. This comprehensive review offers a unique synthesis of current evidence on the aetiology, prevalence, diagnosis, and management of OH, integrating perspectives from neurology, cardiology, and geriatric medicine. It critically appraises the current limitations within clinical guidelines, highlighting the lack of standardised diagnostic protocols and the inadequate recognition of delayed OH and postural hypertension. Particular focus is given to the older population, proposing individualised diagnostic and therapeutic strategies to address their specific clinical vulnerabilities. By adopting a multidisciplinary, patient-centred framework, the review addresses the complexity of diagnosing and managing OH, emphasising both underutilised non-pharmacological interventions and the careful use of pharmacological therapies. It also calls for the urgent revision of national guidelines, including those by the National Institute for Health and Care Excellence, to align with contemporary evidence and improve clinical decision-making. Future research directions are proposed, particularly regarding symptomatic versus asymptomatic OH, the development of refined diagnostic tools, and the long-term impact of symptom control.