Reviews in Clinical Gerontology

Clinical geriatrics

Non-pharmacological management of orthostatic hypotension in the older patient

Daniel J Ryana1 c1, Conal J Cunninghama1 and Chie Wei Fana1

a1 Falls and Blackouts Unit, St James Hospital, Dublin, Ireland


Orthostatic hypotension (OH) occurs in up to 30% of community-dwelling older people. Its presence confers a greater risk of incident co-morbid disease and all-cause mortality. As per guidelines, first-line treatment should consist of non-pharmacological therapies. Effective lifestyle modification advice includes the avoidance of rapid postural changes and large meals. Physical counter-manoeuvres, when comprehensively described, effectively abate symptom progression. Patients should drink 1.5 to 2 litres of water daily, though reports suggest only half of older people comply with this regime. Moderate salt consumption is advised, though with caution as supine hypertension often co-exists. Compression hosiery benefits older people and, contrary to popular opinion, is well tolerated. Potential, future therapies include impedance threshold devices. Older patients with OH frequently have co-morbid disease such that a pharmacological approach is ill-advised. They respond well to non-pharmacological therapies and these should form the primary therapeutic approach.

(Online publication December 20 2011)


c1 Address for correspondence: Dr Daniel Ryan, Falls and Blackouts Unit, St James Hospital, Dublin 8, Ireland. Email: