3.3.3.0 Or­tho­stat­ic Hy­poten­sion

Treat­ing or­tho­stat­ic hy­poten­sion is chal­leng­ing. The ther­apeutic goal is to min­i­mize pos­tu­ral symp­toms rather than to re­store nor­moten­sion. Most pa­tients re­quire both nonphar­ma­co­log­ic mea­sures (e.g., en­sur­ing ad­e­quate salt in­take, avoid­ing med­i­ca­tions that ag­gra­vate hy­poten­sion, or using com­pres­sive gar­ments over the legs and ab­domen) and phar­ma­co­log­ic mea­sures. Phys­i­cal ac­tiv­i­ty and ex­er­cise should be en­cour­aged to avoid de­con­di­tion­ing, which is known to ex­ac­er­bate or­tho­stat­ic in­tol­er­ance, and vol­ume re­ple­tion with fluids and salt is crit­i­cal. Mi­do­drine and drox­i­dopa are ap­proved by the FDA for the treat­ment of or­tho­stat­ic hy­poten­sion.