Defined as a fall in SBP of 20mmHg (30 in patients with HTN), and/or a fall in DBP of 10mmHg within 3 mins of standing

• can be associated with a blunted increase in HR when it has an underlying neurogenic cause (e.g. peripheral neuropathy)
• Clinically significant if associated with symptoms of cerebral hypoperfusion - causing syncope and falls

Risk factors:

• Frailty - normal age related reduction in baroreflex
• medications - alpha blockers, diuretics, antidepressants impair sympathetic tone
• volume depletion/dehydration
• parkinsons disease - a-synuclein deposits affect autonomic regulation
• DLB
• diabetes mellitus (autonomic neuropathy)

PC

• Sx of cerebral hypoperfusion: Postural light-headidness, syncope, visual changes, weakness, fatigue
• Symptoms of underlying cause - parkinsons, DM
• Other sx of autonomic dysfunction - abnormal GI motility, erectile dysfunction, anhidrosis, heat intolerance

Examination:

• BP posture test

Management