Table 1.

Evaluation of the hospitalized patient with orthostatic hypotension

1. Measure orthostatic vitals (Measure blood pressure and heart rate, supine and 1–3 minutes upright)	A ΔHR/ΔSBP ratio <0.5 suggests neurogenic orthostatic hypotension due to impaired autonomic reflexes. A ratio >0.5 suggests a significant contribution of medications, dehydration or deconditioning to orthostatic hypotension.
2. Autonomic function tests and fractionated plasma catecholamines (Rarely available outside specialized centers and not essential for adequate management)	Can help document impaired autonomic reflexes. Low plasma norepinephrine can help with choice of pressor agents (midodrine and droxidopa preferred).
3. Evaluation of associated disorders (depending on clinical conditions)	e.g., glycemic control in diabetics, neurology or cardiology evaluation for movement disorders, heart failure, etc.
4. Rule out autoimmune or paraneoplastic conditions in cases with subacute onset and rapidly progressive disease	Serum and urine immunoelectrophoresis, plasma light chains, autoantibody panel (“PAVAL”, Mayo labs), genetic testing for transthyretin amyloidosis.