Orthostatic hypotension: the last 20 years

In 1999, the 4th edition of the textbook Autonomic failure was published, edited by Sir Roger Bannister—recipient of a lifetime achievement award for his work on autonomic disorders—and Christopher Mathias, Professor of Neurovascular Medicine and director of the two largest clinical autonomic units in the country (Mathias and Bannister, 1999). At more than 500 pages long, the book covers everything from neurobiology of the autonomic nervous system to its pathophysiology and clinical assessment, with 20 new chapters being added since the 1992 edition.

Orthostatic hypotension is described in the book as an often-cardinal feature of autonomic failure, and so reference is made throughout the book to the condition, with the reader learning about its manifestation, investigation and prevention.

Almost 20 years later, the American College of Cardiology, alongside authors from Harvard Medical School, Standford Medical Centre, Saudi Arabia and Texas, published a ‘state-of-the-art review’ into orthostatic hypotension (Freeman et al, 2018). Many of the concepts remain the same, and this article will draw together both texts, alongside other references, to form an overview of the highly prevalent and disabling condition that is orthostatic hypotension.