Delayed orthostatic hypotension is a fall in blood pressure beyond 3 min of standing or upright tilt table testing. The prevalence, clinical features and pathophysiology are reviewed. To date, there is little data to support a standardized or recommended treatment. However, the 10-year mortality rates of individuals with delayed orthostatic hypotension are approximately 50%. Despite the fact that delayed orthostatic hypotension carries the same symptoms, risks and high mortality rate as classical orthostatic hypotension, but is under-recognized. The frequency with which delayed orthostatic hypotension develops into classical orthostatic hypotension, the high associated mortality rates and risk of development of the neurodegenerative disorders classified as alpha-synucleinopathies underscores the need for further study of this condition.