Hypotension

http://www.patient.co.uk/doctor/Hypotension.htm

The key to managing this condition is individually tailored therapy. The goal of treatment is to improve the patient's functional capacity and quality of life, preventing injury, rather than to achieve a target BP.

The patient (and carers) should be educated about the various factors that affect blood pressure and special aspects that have to be avoided, e.g. foods, habits, positions and drugs.
Avoid triggers, e.g. high temperature environments.
Review any medication being taken.
Advise elderly on standing slowly, dorsiflexing the feet first and even crossing the legs whilst upright.
Raising the head of the bed, which helps prevent diuresis and supine hypertension caused by fluid shifts.
Initial intervention is to increase intravascular fluid volume by large daily salt intake, either added to food or as salt tablets:
Continue with this until weight increased by 1.3-2.3 kg; then can consider giving fludrocortisone, if necessary, to increase sodium retention. Dose is 0.1- 0.2 mg/day.1
Can precipitate heart failure but peripheral oedema alone should not cause cessation of treatment.
A morning dose of caffeine as coffee or tablet form can be effective.
If symptoms still persist consider midodrine:
This is a peripherally acting alpha-1-adrenoceptor agonist. It increases BP via vasoconstriction.
It is recommended for mono- or combined therapy, e.g. with fludrocortisone at an initial dosage of 2.5 mg orally two to three times daily, increasing gradually up to 10 mg three times daily.1
Supine hypertension is a common (25%) adverse effect and may be severe. The last dose should be administered at least 4 hours before going to sleep and BP should be monitored.
Some patients become worse on midodrine and it is contraindicated in heart disease, renal failure, phaeochromocytoma and thyrotoxicosis.
Alternatives include dihydroxyphenylserine and octreotide.
Physical counterpressure with compression hosiery, or whole-body inflatable suits may be required.