The association between orthostatic symptoms and orthostatic hypotension: Does it really matter?

Orthostatic hypotension (OH) is a clinical condition arbi- trarily defined by consensus as a fall in systolic/diastolic blood pressures (BPs) of 20/10 mmHg passing from the supine to the upright position during the first 3 minutes. The observation of a BP drop during standing is a frequent condition, mainly in elderly people, associated with different pathophysiological mechanisms and with potential prog- nostic value in several population settings. There are not univocal data from the literature about the prognostic role of OH, mainly concerning cardiovascular risk. Some studies found a significant association between OH and the risk of fall, syncope, mortality and cardiovascular disease, or risk of dementia, but this association is not always confirmed. In general, there is some agreement about the fact that OH could be more a marker of frailty and underling disease leading to increased mortality or cardiovascular risk than a causal condition. The association between symptoms and OH has been investigated in literature. A study systematically testing for OH found that most of the patients presenting OH are asymptomatic. Indeed, even the presence of asymptomatic OH has been shown to be independently associated with mortality and cardiovascular disease, but again, this seems linked to the presence of underlying disease.