Orthostatic Hypotension

Abstract

Neurogenic orthostatic hypotension is a highly prevalent and disabling feature of autonomic failure due to both peripheral and central neurodegenerative diseases. Community-based epidemiological studies have demonstrated a high morbidity and mortality associated with neurogenic orthostatic hypotension. It is due to impairment of baroreflex-mediated vasoconstriction of the skeletal muscle and splanchnic circulation and is caused by damage or dysfunction at central and/or peripheral sites in the baroreflex efferent pathway. Nonpharmacological and pharmacological interventions may be implemented to ameliorate the symptoms of orthostatic intolerance and improve quality of life. Many patients will be adequately treated by education, counseling, removal of hypotensive medications, and other nonpharmacological interventions, whereas more severely afflicted patients require pharmacological interventions. The first stage of pharmacological treatment involves repletion of central blood volume. If unsuccessful, this should be followed by treatment with sympathomimetic agents.

Treatment of Orthostatic Hypotension Due to Autonomic Dysfunction (Neurogenic Orthostatic Hypotension) in a Patient with Cardiovascular Disease and Parkinson's Disease

“…Diabetes mellitus is a common comorbidity in patients with cardiovascular disease. Although there are some similarities between the neuropathy observed in diabetes mellitus and disorders associated with primary autonomic failure [ 22 ], there are limited data on the use of droxidopa in patients with diabetic autonomic neuropathy, because patients with nOH due to diabetic autonomic neuropathy were excluded from the clinical studies leading to US Food and Drug Administration approval. These clinical trials included a few patients with primary autonomic failure and coexistent diabetes mellitus, but no analyses of the diabetic subpopulation were performed.…”

Timing of Circulatory and Neurological Events in Syncope

“…The most common cause of cOH is medication. When the cause concerns structural damage to the sympathetic nervous system, the resulting cOH is often labeled "neurogenic OH" [nOH; (61)]. The damage may be a secondary effect of nerve damage, as in diabetes, amyloidosis, or auto-immune autonomic neuropathy, or it may concern primary autonomic failure, in which the autonomic nervous system suffers primary damage.…”

A Call to Action: The Role of Healthcare Providers in Reducing the Burden Associated with Neurogenic Orthostatic Hypotension

“…1 ) [ 8 , 9 ]. Other agents (e.g., fludrocortisone, pyridostigmine) are commonly used off-label for the treatment of nOH [ 2 , 12 , 13 ] but have limited evidence of efficacy based on results from well-designed trials. Several comprehensive reviews on the management of nOH have been published in the past 3 years and are useful resources for detailed guidance and specific considerations of individual non-pharmacologic and pharmacologic interventions [ 2 , 12 , 13 ].…”