In addition, the clinician should look for common symptoms of autonomic dysfunction, including dry mouth, incontinence, impotence, and abnormal sweating. Treatment of hypotension in the elderly should begin with nonpharmacologic interventions when possible. Obviously, the elimination of drugs that may have a hypotensive effect from the patient's regimen is important and necessary. Waist-high graded compression stockings designed to encourage venous return are effective, as are nocturnal elevation of the head and liberalization of salt intake if patients do not have heart failure. Simply crossing one leg in front of the other may also relieve hypotension while standing.
Lifestyle modifications can assist enormously in the management of hypotension.
Walking exercise can transiently increase blood pressure after meals, ameliorating postprandial hypotension. When all else fails, medications are available for those patients with very severe autonomic or hypotensive symptoms. Usually the mainstay of treatment for the primary care geriatrician is fludrocortisone. Summary Hypotension is an important, yet often overlooked, cause of falls and syncope. Therefore, all patients with falls or syncope should undergo careful blood pressure monitoring at the same time of day and under the same circumstances associated with the falling event.