Neurogenic Orthostatic Hypotension: State of the Art and Therapeutic Strategies

Abstract

Neurogenic orthostatic hypotension (nOH) is a subtype of orthostatic hypotension in which patients have impaired regulation of standing blood pressure due to autonomic dysfunction. Several primary and secondary causes of this disease exist. Patients may present with an array of symptoms making diagnosis difficult. This review article addresses the epidemiology, pathophysiology, causes, clinical features, and management of nOH. We highlight various pharmacological and non-pharmacological approaches to treatment, and review the recent guidelines and our approach to nOH.

Diagnosis of orthostatic hypotension in older people

“…비신경성기립저혈압이 심박출량(cardiac output) 감소와 혈관수축 (vasoconstriction) 부전으로 인해 발생하는 데 비해 신경성기립저 혈압은 자율신경부전에 의해 교감신경계 자극에 따른 노르에피네 프린(norepinephrine) 분비가 충분하지 않으면서 발생한다 [35].…”

“…신경성기립저혈압도 크게 일차자율신경부전(primary autonomic dysfunction)이 발생하는 질환들과 다른 질환들에 의해 이차적으 로 발생하는 것으로 나눌 수 있다(Table 3) [25,29,35]. [41].…”

“…[41]. 그 외에도 아밀로이드증(일차 혹은 가족성), 신생물딸림 (paraneoplastic)자율신경병, 기얭-바레증후군(Guillain-Barre syndrome) 등의 말초신경병과 중추신경계의 종양이나 다발경화 증(multiple sclerosis) 등의 염증성 질환들이 원인이 될 수 있다 (Table 3) [25,29,35].…”

“…그러나 누울 수 있는 환경이 아니라면 5분 이상 앉은 상 태를 유지하였다가 기립혈압을 측정하는 방법도 사용할 수 있다 [31]. 또한 3분까지만 혈압을 측정할 경우 지연기립저혈압을 놓칠 수 있기 때문에 10분까지 측정하는 것을 더 권고한다 [15] Based on [25,29,35].…”

Use of Multimodal Therapies to Treat Severe Orthostatic Hypotension From Autonomic Failure

“…Initial strategies should focus on reversible factors such as culprit medications, treatment of comorbidities, and patient education on conservative therapies [ 3 - 5 ]. In any case, treatment goals should be individually tailored to patients and may require multiple pharmacologic treatments to achieve symptomatic relief [ 5 ]. Herein, we present a case of an 81-year-old male with ischemic cardiomyopathy who presented to our hospital with syncope and required a multimodal treatment regimen to treat his severe symptomatic OH.…”