Postural hypotension in the elderly.

Postural hypotension is a common and important clinical disorder in the elderly population. The pathogenesis is multifactorial but is probably often due to changes in the autonomic nervous system, as well as to age-related changes in the cardiovascular and endocrine systems. In addition, the presence of multiple diseases and medications are common contributing factors. Standardized measurement of postural blood pressure and recording of heart rate and assessment of associated symptoms are essential for the clinical diagnosis. Evaluation and management depend on an initial thorough clinical review of problems. Usually elimination of offending medications and treatment of contributing medical disorders are adequate. Occasionally, use of volume expanders and newer experimental agents is indicated. Postural hypotension can be seen as a prototypical clinical disorder of the elderly. It reflects impaired homeostasis; its etiology is multifactorial and due to the effects of both age and disease; it is clinically protean; and it can result in falls, injury, and progressive decline if not recognized and treated early.