<scp>ASH</scp> Position Paper: Evaluation and Treatment of Orthostatic Hypotension

Shibao, Cyndya A.; Lipsitz, Lewis A.; Biaggioni, Italo

doi:10.1111/jch.12062

Cited by 102 publications

(156 citation statements)

References 35 publications

(59 reference statements)

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…Aging and hypertension are associated with a decrease in baroreflex-mediated cardio acceleration and vasoconstriction, impaired renal salt and water conservation; slow cardiac filling 29 and impairment of compensatory mechanisms is exaggerated with uncontrolled hypertension. 30 This finding is in agreement with the previous studies 19,31 in which the achievement of BP control decreased the risk of OH.…”

Section: Association Of Oh With Hypertensionsupporting

confidence: 83%

Determining the prevalence of orthostatic hypotension and its associations with hypertension and functional decline in the community-dwelling elderly in Vietnam

2017

JCGG

View full text Add to dashboard Cite

Background: Most of studies in the elderly have focused on hypertension (HTN) while orthostatic hypotension (OH) receives little attention. There has been evidenced that OH increases the risk of falling, cognitive impairment and mortality in the elderly. The aim of the study was to determine the prevalence of OH and its relationship with hypertension and functional impairment in elderly people. Methods: A cross-sectional study was conducted in community-dwelling elderly aged ≥ 60 years in Vinh Thanh ward, Cho Lach district, Ben Tre province. Blood pressure was measured in seated and standing position. OH was defined as a drop in systolic blood pressure ≥ 20 mmHg or in diastolic blood pressure ≥ 10 mmHg. Univariate and multivariate logistic regression were used in the analysis to investigate the associations of OH with hypertension and functional impairment in instrumental activities of daily living (IADLs) and activities of daily living (ADLs). Results: A total of 589 subjects were recruited with the mean age 70.4 ± 8.5 years, female was 65.7%. The prevalence of OH was 14.9% and 61.2% of them were asymptomatic. OH was not associated with hypertension, but there was a significant relationship between OH and uncontrolled hypertension (OR=4.06, 95% CI: 1.99-8.2, p <0.001). OH was not associated to functional impairment. Conclusions: Nearly two-thirds of the elderly with OH were asymptomatic. OH was significantly related to uncontrolled hypertension. OH did not relate to ADLs or IADLs impairment.

show abstract

Section: Association Of Oh With Hypertensionsupporting

confidence: 83%

Determining the prevalence of orthostatic hypotension and its associations with hypertension and functional decline in the community-dwelling elderly in Vietnam

2017

JCGG

View full text Add to dashboard Cite

show abstract

“…pressor agents will increase blood pressure for 2 to 3 hours at a time and are best given on a PRN basis, to be taken 30 to 45 minutes before upright activities. 25 Evening doses should be avoided because of increased risk of supine hypertension.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Atomoxetine Versus Midodrine for the Treatment of Orthostatic Hypotension in Autonomic Failure

et al. 2014

Self Cite

View full text Add to dashboard Cite

The clinical presentation of autonomic failure is orthostatic hypotension. Severely affected patients require pharmacologic treatment to prevent pre-syncopal symptoms or frank syncope. We previously reported in a proof of concept study that pediatric doses of the norepinephrine transporter blockade, atomoxetine, increases blood pressure in autonomic failure patients with residual sympathetic activity compared with placebo. Given that the sympathetic nervous system is maximally activated in the upright position, we hypothesized that atomoxetine would be superior to midodrine, a direct vasoconstrictor, in improving upright blood pressure and orthostatic hypotension-related symptoms. To test this hypothesis, we compared the effect of acute atomoxetine versus midodrine on upright systolic blood pressure and orthostatic symptom scores in 65 patients with severe autonomic failure. There were no differences in seated systolic blood pressure (95% CI= −7.3 to 7.9, P=0.94) or seated diastolic blood pressure (95% CI= −3.4 to 4.2, P=0.83) between atomoxetine and midodrine. In contrast, atomoxetine produced a greater pressor response in upright systolic blood pressure (95% CI= 0.6 to 15, P=0.03) and upright diastolic blood pressure (95% CI=-0.05 to 8.3, P=0.05), compared with midodrine. Furthermore, atomoxetine (95% CI=0.1 to 0.8, P=0.02), but not midodrine (95% CI=-0.1 to 1.0, P=0.08), improved orthostatic hypotension-related symptoms as compared with placebo. The results of our study suggest that atomoxetine could be a superior therapeutic option than midodrine for the treatment of orthostatic hypotension in autonomic failure.

show abstract

“…Orthostatic hypotension is more frequent in patients with diabetes mellitus and is accompanied by higher incidence rates of falls, fractures and early death (8). Orthostatic hypotension can occur occasionally depending on the time of day and other medications being taken.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension and Therapy with an Ace Inhibitor in Hypertensive Patients

Tasić

Dragisic

et al. 2017

Serbian Journal of Experimental and Clinical Research

View full text Add to dashboard Cite

show abstract

ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension

Cited by 102 publications

References 35 publications

Determining the prevalence of orthostatic hypotension and its associations with hypertension and functional decline in the community-dwelling elderly in Vietnam

Determining the prevalence of orthostatic hypotension and its associations with hypertension and functional decline in the community-dwelling elderly in Vietnam

Efficacy of Atomoxetine Versus Midodrine for the Treatment of Orthostatic Hypotension in Autonomic Failure

Orthostatic Hypotension and Therapy with an Ace Inhibitor in Hypertensive Patients

Contact Info

Product

Resources

About