Primary prevention
Medications that trigger orthostatic hypotension (OH) should be avoided in susceptible populations. Common medications known to trigger OH are alpha-blockers (used for treating conditions such as benign prostatic hypertrophy), central sympatholytics (e.g., tizanidine used as a muscle relaxant, and methyldopa to treat hypertension), tricyclic antidepressants, phosphodiesterase-5 inhibitors (used to treat conditions such as erectile dysfunction), and other antihypertensive agents, particularly beta-blockers.[15][18] Levodopa and dopaminergic agonists have been associated with OH, but evidence is not consistent.[24][25][26]
Dehydration and diets that are extremely low in sodium should be avoided in susceptible populations.
Tight glycaemic control has been shown to delay progression of autonomic neuropathy in type 1 diabetes, but not in type 2 diabetes.
Secondary prevention
Patients with OH should be aware that their condition makes them more susceptible to syncope, thereby rendering them more vulnerable to falls. Educating patients about the effects of posture, medications, and hydration on blood pressure, and the need to use physical counter-manoeuvres is important to prevent falls.[38]
Patients should be told to avoid being supine during the day because of the increased incidence of supine hypertension in patients with OH caused by chronic autonomic failure. Patients should be instructed to sleep with the head of the bed elevated at 30° or as tolerated.
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