China has entered an aging society, and the aging process is inevitably accompanied by a decrease in various organ functions and physiological reflex activities, and the emergence of various geriatric diseases. Orthostatic hypotension is one of its representatives, and it is closely associated with falls, fractures, ischemic attacks, syncope and myocardial infarction in middle-aged and elderly people, increasing the mortality rate in this population. The risk of the disease increases with age. The body will have 500 to 1000 ml of blood converging into the lower extremities and visceral circulation when standing, resulting in reduced venous return and reduced ventricular filling. These hemodynamic changes trigger compensatory reflexes through pressure receptors in the carotid sinus and aortic arch to increase peripheral circulatory resistance, venous return and cardiac output, which in turn reduces the blood pressure drop to maintain blood perfusion to the brain. In the elderly, the response to pressure reflexes decreases, vascular compliance decreases, vestibular sympathetic reflexes are attenuated, vasodilation and contraction are dysfunctional in the upright position, and effective cerebral blood perfusion cannot be ensured, resulting in postural hypotension and cerebral hypoperfusion, highlighted by dizziness, weakness, nausea, and in severe cases, syncope (blackness before the eyes, loss of consciousness, fainting), blurred vision, neck and shoulder pain. In severe cases, dizziness (blackness, loss of consciousness, fainting, blurred vision), neck and shoulder pain. Some patients start to stand without obvious dizziness, but after standing for a long time, the above symptoms gradually appear; even some elderly people may have the possibility of postural hypotension even without obvious symptoms, and accidents can happen at any time. Therefore, upright dizziness in middle-aged and elderly people often suggests the possibility of upright hypotension. The diagnosis of postural hypotension is mainly based on the level of blood pressure in the prone and upright positions, and is generally confirmed by a drop in systolic blood pressure of at least 20-30 mmHg or diastolic blood pressure of 10-20 mm Hg within l-3 minutes after rising from the supine position. There are many causes of upright hypotension, including degenerative diseases of the central nervous system, such as multisystem atrophy, Lewy body dementia, Parkinson’s disease, etc. Peripheral nerve diseases, such as amyloidosis, paraneoplastic, diabetic peripheral neuropathy, as well as pernicious anemia, spinal cord consumption, and autonomic failure, can also cause upright hypotension. In addition, severe stenotic lesions of the major intracranial and extracranial vessels (subclavian artery, vertebral artery, and bilateral internal carotid arteries) can also cause upright dizziness and even syncope. Secondary hypertension, such as hypertension in the prone position and decreased blood pressure in the upright position, occurs in most patients with pheochromocytoma and primary aldosteronism. Therefore, in order to make a clear diagnosis patients need to undergo a series of tests, including routine blood, biochemistry, folic acid, vitamin B12, fasting and postprandial glucose, MRI/MRA of the head, ultrasound of neck and intracranial vessels, upright tilt test, and even electromyography, etc. It is recommended that patients try to go to the neurology department of a regular hospital for treatment according to the specific cause.