To be significant the blood pressure must fall >30mmHg and stay down for at least 1 minute and be accompanied by dizziness.
Main differential diagnoses and typical outline evidence
| Drug induced due to excessive dose of hypotensive agent, L-dopa, carbidopa, phenothiazines, antidepressants | Suggested by: drug history. |
| Confirmed by: by resolution or improvement after stopping or reducing drug. | |
| Autonomic neuropathy due to diabetes mellitus or tabes dorsalis (rarely) | Suggested by: history of long standing diabetes (common) or tabes dorsalis (rare). Also, diarrhoea, abdominal distension and vomiting (gastroparesis), impotence, urine frequency. |
| Confirmed by: ECG monitor of beat to beat variation: <10> | |
| Management: OHCM p298. | |
| Idiopathic orthostatic hypotension | Suggested by: no other features except elderly. |
| Confirmed by: isolated phenomenon. |
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