For many years, the problem of chronic hypotension has been in the shadow of hypertension; it has been underrecognized, underinvestigated, and almost certainly undertreated. It is frequently overlooked because it can be detected only if blood pressure is measured in the upright posture (the supine blood pressure is actually elevated in many of the most severely affected patients). In some patients it is only present in the hour after a carbohydrate-rich meal and will be missed if sought at other times.
Many disorders may give rise to orthostatic hypotension. In some patients, severe autonomic failure may occur in the absence of other neurologic problems (Bradbury-Eggleston syndrome or idiopathic orthostatic hypotension),1 whereas in others there may be associated extrapyramidal, cerebellar, or other neurologic involvement (Shy-Drager syndrome or multiple system atrophy).2 Autonomic failure may also occur as a complication of amyloidosis or diabetes mellitus, or as a remote effect of
Robertson D, Biaggioni I. Orthostatic Hypotension: More Heterogeneity. Arch Intern Med. 1992;152(5):919. doi:10.1001/archinte.1992.00400170009001
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