Advanced practice nurses are responsible for diagnosing and treating patients with acute onset hypotension. The potential diagnostic hypotheses for hypotension are related to a wide variety of pathophysiologic processes. These processes are represented by the acronym VINDICATE--Vascular (and cardiac), Inflammatory, Neoplastic, Degenerative, Intoxication/Iatrogenic, Congenital, Allergic/Autoimmune, Traumatic, Endocrine/Metabolic However, acute onset hypotension experienced by the adult patient in the hospital is likely to be caused by the vascular (and cardiac) processes of absolute hypovolemia, relative hypovolemia, and pump failure. Developing the differential diagnosis for acute onset hypotension involves making a series of clinical decisions in a stepwise manner. The clinician bases these decisions on information contained in a subjective and objective database and on recognizing patterns in the central findings. However, treatment of hypotension may be necessary before or during the diagnostic process, depending on the severity of the patient's symptoms.