Perspectives on the treatment of orthostatic hypotension associated with hypertension

Orthostatic hypotension is defined as a reduction in systolic blood pressure of at least 20 mmHg or a reduction in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing up. The frequent and rapid cardiovascular adjustments essential for homeostatic control of blood pressure are not accomplished in patients with orthostatic hypotension, who experience symptomatic and often extreme high and low blood pressure variations. In most cases, the underlying cause of orthostatic hypotension is not amenable to correction, and patients have lifelong symptoms. Current treatment strategies are directed at improving patients' symptoms by raising blood pressure. Such interventions, however, do not address the coincident problems of extreme high blood pressure, nocturnal hypertension, and resultant end-organ damage present in these patients.