SYMPTOM CONTROL AND PATIENT SAFETY IN CHRONIC ORTHOSTATIC HYPOTENSION

  2. 2026
  3. SYMPTOM CONTROL AND PATIENT SAFETY IN CHRONIC ORTHOSTATIC HYPOTENSION

Zhdan V. M., Babanina M. Yu., Volchenko H. V., Kitura Ye. M., Tkachenko M. V., Kyrian O. A., Ivanitsky I. V., Lebed V. G.

SYMPTOM CONTROL AND PATIENT SAFETY IN CHRONIC ORTHOSTATIC HYPOTENSION

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About the author:

Zhdan V. M., Babanina M. Yu., Volchenko H. V., Kitura Ye. M., Tkachenko M. V., Kyrian O. A., Ivanitsky I. V., Lebed V. G.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

Chronic orthostatic hypotension is a form of hemodynamic decompensation that leads to reduced daily activity, falls and injuries, cognitive decline, frequent hospitalizations, and increased mortality – particularly in older patients with cardiovascular, endocrine, and neurologic comorbidities. The magnitude of blood pressure decline does not always correlate with symptom severity; therefore, it is advisable to consider not only hemodynamic criteria – such as a decrease in systolic blood pressure by ≥20 mmHg or diastolic blood pressure by ≥10 mmHg within the first minutes after standing – but also functional limitations and the risk of complications. The article discusses the multifactorial pathophysiology, including autonomic dysfunction, impaired vascular tone, hypovolemia, and iatrogenic influences, as well as the role of neurodegenerative conditions. A stepwise, personalized strategy for symptom control is proposed: patient education; slow postural changes; avoidance of overheating, dehydration, and alcohol; adherence to appropriate meal practices; isometric exercises; optimization of fluid intake; salt loading; compression therapy; abdominal binders; individualized exercise training; and review of concomitant pharmacotherapy. The role of medications as the next step is outlined, including midodrine, fludrocortisone, droxidopa, pyridostigmine, and other second-line agents in titrated doses. Treatment safety is addressed separately, focusing primarily on the risk of supine hypertension, the need to adjust evening dosing, positional measures, regular monitoring, and principles of management when chronic orthostatic hypotension coexists with arterial hypertension, heart failure, or diabetes mellitus. It is noted that phenylephrine (mezaton), dopamine, “prophylactic” infusions of solutions, or caffeine are inappropriate for long-term management of chronic orthostatic hypotension and should be used only in acute, lifethreatening conditions. Fall prevention includes the use of support when standing up, adequate lighting, non-slip footwear, and multidisciplinary follow-up for patients at high risk of complications.

Tags:

autonomic dysfunction, autonomic failure, comorbidity, compression therapy, droxidopa, fludrocortisone, midodrine, orthostatic hypotension, orthostatic tolerance, postprandial hypotension, pyridostigmine

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 2, 181, 56-62 pages, index UDC 616.12-008.331.4-071-085

DOI:

10.29254/2077-4214-2026-2-181-56-62

2026 Issue 2, 181
autonomic dysfunction autonomic failure comorbidity compression therapy droxidopa fludrocortisone midodrine orthostatic hypotension orthostatic tolerance postprandial hypotension pyridostigmine
27.05.2026
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