Orthostatic hypotension (OH) is a common but underrecognized disorder defined by an abnormal fall in blood pressure on standing. It reflects impaired autonomic and cardiovascular adaptation to postural change, leading to transient cerebral hypoperfusion. Beyond immediate symptoms such as dizziness and syncope, OH is associated with long-term risks including falls, fractures, cognitive decline, and cardiovascular morbidity. This review synthesizes current evidence on epidemiology, definitions, pathophysiology, diagnostic approaches, management strategies, and future directions. Four phenotypes, including initial, classical, delayed, and delayed recovery, represent a clinical continuum from transient to sustained autonomic failure. Diagnosis relies primarily on the active standing test, with tilt-table and beat-to-beat monitoring enhancing detection of atypical forms. Home and ambulatory blood pressure monitoring provide additional insight into supine hypertension and postprandial patterns. Management prioritizes symptom control and prevention of complications through stepwise strategies: Lifestyle modification, volume and salt expansion, compression therapy, and pharmacological agents such as midodrine, droxidopa, and fludrocortisone. Drug selection and dosing must account for comorbid hypertension and supine hypertension risk. Recent research highlights phenotype-specific prognostic differences and emerging options, including pyridostigmine, atomoxetine, and device-based abdominal compression. Digital phenotyping through home or beat-to-beat monitoring may enable personalized management. The evolving understanding of OH underscores the importance of individualized, evidence-based care aimed at functional improvement and reduction of adverse outcomes rather than strict normalization of blood pressure.