Orthostatic hypotension and cardiovascular events: An underestimated relationship in geriatrics

Orthostatic hypotension is a common and underestimated condition in the geriatric population, characterized by a significant decrease in blood pressure upon standing. Its pathophysiology centers on dysfunction of the baroreflex system, affected by neurodegeneration and arterial stiffness, which impedes an adequate autonomic response to postural changes. This impairment is aggravated by decreased intravascular volume, common in older adults due to dehydration, malnutrition, and diuretic use. Clinically, it manifests with symptoms such as dizziness, blurred vision, and syncope, increasing the risk of falls, fractures, and cardiovascular events.
Diagnosis is based on standardized criteria, which require serial blood pressure measurements in the supine and standing positions, as well as complementary tools such as the tilt test and ambulatory monitoring. Orthostatic hypotension has been associated with an increased risk of myocardial infarction, stroke, cognitive decline, and functional frailty. Comorbidities such as type 2 diabetes mellitus and Parkinson's disease contribute significantly to its prevalence and severity.
Therapeutic management begins with non-pharmacological interventions, such as adequate hydration, physical exercises, and the use of compression garments. Adjustment of antihypertensive medications is essential, and in resistant cases, pharmacological treatments such as fludrocortisone, midodrine, or droxidopa are used. Geriatric follow-up should be comprehensive and multidisciplinary, considering comorbidities and risk factors. Early detection and a personalized approach are key to reducing complications and improving the quality of life of affected older adults.