-
Drug and Therapeutics Bulletin Nov 2020Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care.... (Review)
Review
Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.
Topics: Blood Pressure; Drug-Related Side Effects and Adverse Reactions; Humans; Hypertension; Hypotension, Orthostatic; Life Style; Practice Guidelines as Topic; Supine Position
PubMed: 33127610
DOI: 10.1136/dtb.2020.000056 -
Semergen Oct 2017Orthostatic hypotension is an anomaly of growing interest in scientific research. Although certain neurogenic diseases are associated with this phenomenon, it can also... (Review)
Review
Orthostatic hypotension is an anomaly of growing interest in scientific research. Although certain neurogenic diseases are associated with this phenomenon, it can also be associated with non-neurological causes. Although orthostatic hypotension is defined by consensus as a decrease in the systolic blood pressure of at least 20mmHg, or a decrease in diastolic blood pressure of at least 10mmHg, within 3min of standing, the studies differ on how to diagnose it. Orthostatic hypotension is associated with certain cardiovascular risk factors and with drug treatment, but the results are contradictory. The purpose of this review is to update the knowledge about orthostatic hypotension and its treatment, as well as to propose a method to standardise its diagnosis.
Topics: Blood Pressure; Cardiovascular Diseases; Humans; Hypotension, Orthostatic; Posture; Risk Factors
PubMed: 27865581
DOI: 10.1016/j.semerg.2016.09.006 -
Cardiology in Review 2001Upright posture requires rapid and effective circulatory and neurologic compensations to maintain blood pressure and consciousness. Although it has been recognized over... (Review)
Review
Upright posture requires rapid and effective circulatory and neurologic compensations to maintain blood pressure and consciousness. Although it has been recognized over the past 100 years or more that the act of standing may cause hypotension in patients with autonomic dysfunction, only recently several of the pathophysiologic mechanisms resulting in orthostatic intolerance have been discovered. In patients with orthostatic hypotension, failure of reflex vasoconstriction causes pooling of blood in the legs during standing. Not everyone with a postural blood pressure drop requires treatment, nor does everyone with posturally induced symptoms have orthostatic hypotension. This review will discuss current knowledge of a broad, heterogeneous group of disturbances in the autonomic nervous system, each of which is manifested by hypotension, orthostatic intolerance, and often syncope.
Topics: Humans; Hypotension, Orthostatic; United States
PubMed: 11696263
DOI: 10.1097/00045415-200111000-00010 -
Expert Review of Cardiovascular Therapy Nov 2015Orthostatic hypotension (OH) leads to a significant number of hospitalizations each year, and is associated with significant morbidity and mortality among affected... (Review)
Review
Orthostatic hypotension (OH) leads to a significant number of hospitalizations each year, and is associated with significant morbidity and mortality among affected individuals. Given the increased risk for cardiovascular events and falls, it is important to identify the underlying etiology of OH and to choose appropriate therapeutic agents. OH can be non-neurogenic or neurogenic (arising from a central or peripheral lesion). The initial evaluation includes orthostatic vital signs, complete history and a physical examination. Patients should also be evaluated for concomitant symptoms of post-prandial hypotension and supine hypertension. Non-pharmacologic interventions are the first step for treatment of OH. The appropriate selection of medications can also help with symptomatic relief. This review highlights the pathophysiology, clinical features, diagnostic work-up and treatment of patients with neurogenic OH.
Topics: Humans; Hypertension; Hypotension, Orthostatic
PubMed: 26427904
DOI: 10.1586/14779072.2015.1095090 -
British Journal of Nursing (Mark Allen... May 2020Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic... (Review)
Review
Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92 000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.
Topics: Female; Humans; Hypotension, Orthostatic; Middle Aged; Nursing Diagnosis; Unconsciousness
PubMed: 32407222
DOI: 10.12968/bjon.2020.29.9.506 -
Seminars in Neurology Oct 2020This review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on... (Review)
Review
This review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on novel treatment strategies and new insights into the mechanism underlying these conditions. Our goal is to provide practical advice for clinicians on how to screen, diagnose, and treat these conditions with nonpharmacological and pharmacological approaches. For each disorder, we offered a stepwise recommendation on how to apply these new concepts to successfully ameliorate the symptoms associated with OH to prevent syncope and falls. The management of OH in patients who also have supine hypertension requires special considerations and pharmacotherapy. It is noteworthy that there are few therapeutic options for OH and only two Food and Drug Administration-approved drugs for the treatment of OH and nOH based on randomized clinical trials. We will use these studies to develop evidence-based guidelines for OH. The research is limited for postprandial hypotension and supine hypertension, and therefore the recommendations will be based on small studies, clinical expertise, and, above all, an understanding of the underlying pathophysiology.
Topics: Autonomic Nervous System Diseases; Humans; Hypertension; Hypotension; Hypotension, Orthostatic
PubMed: 33058087
DOI: 10.1055/s-0040-1713886 -
The American Journal of Medicine Jan 2022Orthostatic hypotension is a frequent cause of falls and syncope, impairing quality of life. It is an independent risk factor of mortality and a common cause of... (Review)
Review
Orthostatic hypotension is a frequent cause of falls and syncope, impairing quality of life. It is an independent risk factor of mortality and a common cause of hospitalizations, which exponentially increases in the geriatric population. We present a management plan based on a systematic literature review and understanding of the underlying pathophysiology and relevant clinical pharmacology. Initial treatment measures include removing offending medications and avoiding large meals. Clinical assessment of the patients' residual sympathetic tone can aid in the selection of initial therapy between norepinephrine "enhancers" or "replacers." Role of splanchnic venous pooling is overlooked, and applying abdominal binders to improve venous return may be effective. The treatment goal is not normalizing upright blood pressure but increasing it above the cerebral autoregulation threshold required to improve symptoms. Hypertension is the most common associated comorbidity, and confining patients to bed while using pressor agents only increases supine blood pressure, leading to worsening pressure diuresis and orthostatic hypotension. Avoiding bedrest deconditioning and using pressors as part of an orthostatic rehab program are crucial in reducing hospital stay.
Topics: Disease Management; Humans; Hypotension, Orthostatic; Inpatients
PubMed: 34416163
DOI: 10.1016/j.amjmed.2021.07.030 -
The Medical Clinics of North America Nov 1989Orthostatic hypotension is a rare finding in healthy elderly subjects, but is a common clinical problem in older patients. Assessment of symptoms and the blood pressure... (Review)
Review
Orthostatic hypotension is a rare finding in healthy elderly subjects, but is a common clinical problem in older patients. Assessment of symptoms and the blood pressure response to standing is an important part of the initial evaluation and follow-up of geriatric patients. Generally, more than one cause will be identified, and these patients respond to simple treatment measures. Identification and treatment of this disorder will improve function and independence in this population.
Topics: Aged; Aging; Blood Pressure; Blood Pressure Determination; Diagnosis, Differential; Humans; Hypotension, Orthostatic; Risk Factors
PubMed: 2682064
DOI: 10.1016/s0025-7125(16)30602-2 -
Movement Disorders : Official Journal... Jul 2016Orthostatic hypotension and cognitive impairment are common in Parkinson's disease (PD) and significantly impair quality of life. Orthostatic hypotension and cognitive... (Review)
Review
Orthostatic hypotension and cognitive impairment are common in Parkinson's disease (PD) and significantly impair quality of life. Orthostatic hypotension and cognitive impairment appear to be interrelated. Whether the relationship is causative or associative remains unclear. The vascular hypothesis proposes that recurrent episodic hypotension results in cerebral hypoperfusion, in turn causing anoxic damage to vulnerable areas of the brain and impaired cognitive function. Support for this hypothesis has come from brain MRI studies showing an association between white matter hyperintensities and a postural drop in blood pressure among PD patients. Alternatively, the association between orthostatic hypotension and cognitive decline in PD may reflect shared underlying synuclein-related pathology affecting common neuroanatomical and neurochemical substrates. Cardiac imaging studies demonstrate noradrenergic denervation early in PD, and cardiac denervation has been associated with poorer cognition. Neurogenic orthostatic hypotension occurs as a result of defective norepinephrine release from sympathetic terminals upon standing. Neuropathological studies have also demonstrated Lewy body pathology in the locus coeruleus; the main source of noradrenaline in the brain. Locus coeruleus norepinephrine levels are reduced in PD patients with dementia when compared with PD patients without. In this review, we examine the evidence for an association between orthostatic hypotension and cognitive impairment in PD. We evaluate the literature supporting the hypothesis that progressive noradrenergic denervation underlies both orthostatic hypotension and cognitive impairment, and we examine studies suggesting that recurrent cerebral hypoperfusion results in cognitive decline in PD. Finally, we explore how modulation of blood pressure and the noradrenergic nervous system may improve cognition in PD. © 2016 International Parkinson and Movement Disorder Society.
Topics: Cognitive Dysfunction; Humans; Hypotension, Orthostatic; Parkinson Disease
PubMed: 27091624
DOI: 10.1002/mds.26632 -
Journal of Cardiovascular Medicine... Feb 2015Orthostatic hypotension commonly affects elderly patients and those suffering from diabetes mellitus and Parkinson's disease. It is a cause of significant morbidity in... (Review)
Review
Orthostatic hypotension commonly affects elderly patients and those suffering from diabetes mellitus and Parkinson's disease. It is a cause of significant morbidity in the affected patients. The goal of this review is to outline the pathophysiology, evaluation, and management of the patients suffering from orthostatic hypotension.
Topics: Autonomic Nervous System Diseases; Disease Management; Humans; Hypotension, Orthostatic; Posture
PubMed: 24933201
DOI: 10.2459/01.JCM.0000446386.01100.35