Complications
Falls in older people are a significant cause of morbidity and mortality. If orthostatic hypotension (OH) is severe enough to compromise blood supply to the brain, syncope and loss of postural tone can occur. In patients with OH, the likelihood of syncope is markedly increased, especially when there is a combination of aggravating factors (e.g., cutaneous vasodilation during hot weather, dehydration, prolonged standing).
The most important measure for preventing OH-induced falls is patient education (i.e., avoiding triggers of OH, learning to recognise symptoms and to sit down immediately to avoid syncope, and using physical counter-manoeuvres aimed at increasing venous return during orthostatic stresses).
In 50% of patients with severe autonomic impairment, circadian blood pressure rhythms are lost, and blood pressure is elevated at night. This causes end-organ damage.
Periodic measurements of left ventricular thickness and serum creatinine levels are necessary to monitor the progression of end-organ damage in patients with supine hypertension.
Patients should not lie down during the day. Sleeping with the head of the bed elevated reduces supine hypertension.
Short-acting antihypertensive drugs taken at bedtime may be required.
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