{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:23:04Z","timestamp":1785331384741,"version":"3.55.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2018,7,2]],"date-time":"2018-07-02T00:00:00Z","timestamp":1530489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Orthostatic hypotension (OH) is an important and common medical problem, particularly in the frail elderly with multiple comorbidities and polypharmacy. OH is an independent risk factor for falls and overall mortality. Hypertension is among the most common comorbidities associated with OH, and its presence complicates the management of these patients because treatment of one can worsen the other. However, there is evidence that uncontrolled hypertension worsens OH so that both should be managed. The limited data available suggest that angiotensin receptor blockers and calcium channel blockers are preferable antihypertensives for these patients. Patients with isolated supine hypertension can be treated with bedtime doses of short-acting antihypertensives. Treatment of OH in the hypertensive patients should focus foremost on the removal of drugs that can worsen OH, including ones that are easily overlooked, such as tamsulosin, tizanidine, sildenafil, trazodone, and carvedilol. OH and postprandial hypotension can be prevented with abdominal binders and acarbose, respectively, without the need to increase baseline blood pressure. Upright blood pressure can be improved by harnessing residual sympathetic tone with atomoxetine, which blocks norepinephrine reuptake in nerve terminals, and pyridostigmine, which facilitates cholinergic neurotransmission in autonomic ganglia. Oral water bolus acutely but transiently increases blood pressure in autonomic failure patients. If traditional pressor agents are needed, midodrine and droxidopa can be used, administered at the lowest dose and frequency that improves symptoms. Management of OH in the hypertensive patient is challenging, but a management strategy based on understanding the underlying pathophysiology can be effective in most patients.<\/jats:p>","DOI":"10.1093\/ajh\/hpy089","type":"journal-article","created":{"date-parts":[[2018,6,28]],"date-time":"2018-06-28T03:24:20Z","timestamp":1530156260000},"page":"1255-1259","source":"Crossref","is-referenced-by-count":57,"title":["Orthostatic Hypotension in the Hypertensive Patient"],"prefix":"10.1093","volume":"31","author":[{"given":"Italo","family":"Biaggioni","sequence":"first","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, and Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,7,2]]},"reference":[{"key":"2022111615430171700_CIT0001","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.amjmed.2007.05.009","article-title":"Orthostatic hypotension-related hospitalizations in the United States","volume":"120","author":"Shibao","year":"2007","journal-title":"Am J Med"},{"key":"2022111615430171700_CIT0002","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1038\/jhh.2014.130","article-title":"Orthostatic hypotension in a cohort of hypertensive patients referring to a hypertension clinic","volume":"29","author":"Di Stefano","year":"2015","journal-title":"J Hum Hypertens"},{"key":"2022111615430171700_CIT0003","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1093\/ageing\/afp192","article-title":"The association between orthostatic hypotension and medication use in the British Women\u2019s Heart and Health 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