How to manage a 76-year-old female with hypotension?

From the Research

Management of Hypotension in a 76-year-old Female

To manage a 76-year-old female with hypotension, the following steps can be taken:

• Identify the underlying cause of hypotension, which can be due to various factors such as comorbidities, polypharmacy, and physiological changes that occur with aging 1
• Assess the patient's symptoms, medical history, and perform serial blood pressure measurements to diagnose orthostatic hypotension (OH) 1, 2
• Implement nonpharmacological interventions as the primary goal of management, including avoidance of potentially hypotensive medications and use of physical counter maneuvers 3, 4
• Consider pharmacological management if nonpharmacological interventions fail, using agents such as fludrocortisone, midodrine, and nonsteroidal anti-inflammatory drugs 4
• Adopt a stepped-care approach to management, allowing for maximum benefit with the least number of drugs and minimizing side effects 3, 2

Diagnostic Evaluation

The diagnostic evaluation of orthostatic hypotension in the elderly requires:

• A comprehensive history including symptoms of autonomic nervous system dysfunction 4
• Careful blood pressure measurement at various times of the day and after meals or medications 4
• Laboratory studies to exclude diagnoses of neurodegenerative diseases, amyloidosis, diabetes, anemia, and vitamin deficiency as the cause 4

Treatment Goals

The goals of treatment for orthostatic hypotension in the elderly are to:

• Improve symptoms 4
• Enhance patient safety 1
• Make the patient as ambulatory as possible, rather than trying to achieve arbitrary blood pressure goals 4