Summary

• An independent predictor of mortality and the cause of significant morbidity associated with falls.
• A common problem in frail older people. Orthostatic hypotension-related hospitalisations increase markedly with age.
• Common causes include drugs (e.g., the alpha-adrenergic blocker tamsulosin, used for benign prostatic hypertrophy), diseases causing peripheral neuropathy (e.g., diabetes mellitus), and Parkinson's disease.
• Primary neurodegenerative disorders of the autonomic nervous system (pure autonomic failure, and multiple system atrophy or Shy-Drager syndrome) are less common, but cause severe orthostatic hypotension.
• Acute or subacute onset should suggest an autoimmune or paraneoplastic disorder.
• Treatment consists of addressing any underlying pathology, when possible. Volume expansion, including mineralocorticoid therapy, short-acting vasopressors, or erythropoietin, are adjunctive therapies when non-pharmacological measures are insufficient.