title: New Horizons in orthostatic hypotension.
abstract: orthostatic hypotension (OH) is a common disabling condition associated with increased morbidity and mortality. Much of the evidence available is derived from younger populations with chronic neurological disease leading to uncertainty for the diagnosis and management of older people.
  
  
  
  to provide an overview of recent and emerging evidence for the diagnosis, management and prognosis of OH in older persons.
  
  
  
  a narrative review of recent studies, emerging therapies and relevant regulatory updates.
  
  
  
  revisions to the diagnostic criteria for OH include the duration of the blood pressure drop, specific criteria for initial and delayed OH and OH with hypertension. Non-drug therapies remain the first-line treatment option and Comprehensive Geriatric Assessment appears to result in lower rates of OH. Recent evidence concerning withdrawal of causative medication is inconsistent. Midodrine has recently become the only licenced medication for OH in the UK. Other emerging treatments include atomoxetine and droxidopa but these require further evaluation. Many other agents may be used but are not supported by high-quality evidence. The increase in mortality associated with OH is less apparent in older people.
  
  
  
  OH remains common in older people, the new diagnostic criteria address some of the previous uncertainty but evidence concerning withdrawal of antihypertensives is conflicting. Midodrine is now the only licenced medication for OH in the UK, but non-drug therapies remain first line and fludrocortisone may be considered before midodrine. We may see other agents such as droxidopa becoming increasingly used over the coming years.
authors.affiliation: Newcastle University-Institute of Cellular Medicine, Newcastle upon Tyne NE1 7RU, United Kingdom of Great Britain and Northern Ireland.|The Newcastle upon Tyne Hospitals NHS Foundation Trust-Falls and Syncope Service, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Frith
authors.affiliation: Newcastle University-Institute of Cellular Medicine, Newcastle upon Tyne NE1 7RU, United Kingdom of Great Britain and Northern Ireland.|The Newcastle upon Tyne Hospitals NHS Foundation Trust-Falls and Syncope Service, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Parry
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D005438:Fludrocortisone / Q000627:therapeutic use; D015577:Geriatric Assessment; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D008879:Midodrine / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D014662:Vasoconstrictor Agents; D008879:Midodrine; D005438:Fludrocortisone
keywords: geriatrics; older people; orthostatic hypotension