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Clinical Autonomic Research : Official... Jul 2017
Topics: Blood Pressure Monitoring, Ambulatory; Disease Management; Humans; Hypertension; Hypotension, Orthostatic
PubMed: 28620715
DOI: 10.1007/s10286-017-0437-3 -
Heart Failure Reviews Sep 2016Orthostatic hypotension (OH) is traditionally defined as a fall of ≥20 mmHg in systolic and/or ≥10 mmHg in diastolic blood pressure within 3 min of active... (Review)
Review
Orthostatic hypotension (OH) is traditionally defined as a fall of ≥20 mmHg in systolic and/or ≥10 mmHg in diastolic blood pressure within 3 min of active standing. OH is a common comorbidity among patients with heart failure (HF). A comprehensive review regarding the relationship between OH and HF has not been published in the English literature. Here we provide current information about concomitant HF and OH, including: pathophysiology, methods of evaluation, prevalence, risk factors, prognosis and management of OH in HF patients, as well as the incidence of HF among patients with OH. The prevalence of OH in HF ranges from 8 % among community-living individuals to 83 % in elderly hospitalized patients. Dizziness and palpitations are the most frequent OH symptoms. Main predisposing factors for OH are HF severity, non-ischemic HF etiology, prolonged bed rest, hypertension and polypharmacy. OH in HF is generally managed according to recommendations for treatment of OH in the non-HF population. However, since acceptable pharmacotherapy with fludrocortisone and midodrine is problematic in HF due to adverse effects, the management of OH is based mainly on non-pharmacologic interventions. Several prospective epidemiological studies reported that OH is independently associated with an increased risk of developing HF. Since OH is a common and frequently symptomatic condition in HF patients, its clinical implications should be emphasized. Longitudinal studies should be conducted to investigate the prognostic significance and optimal management of OH in the HF population.
Topics: Aged; Blood Pressure; Comorbidity; Disease Management; Heart Failure; Humans; Hypotension, Orthostatic; Prognosis; Risk Factors
PubMed: 26880254
DOI: 10.1007/s10741-016-9541-z -
Blood Pressure Jun 2019Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation....
PURPOSE
Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation. Moreover, substantial gaps in the skills and knowledge required for assessment of OH have been reported by clinicians. We aimed to provide current information regarding the definition, classification and evaluation of OH.
METHODS
We performed a comprehensive search of medical databases, using the following keywords: "postural hypotension" or "orthostatic hypotension", combined with: "definition", "classification", "diagnosis", "evaluation" or "meaning". We selected for this review the most relevant recent publications and key papers in the field, published in the English language.
RESULTS
Current data regarding definitions, classification and the evaluation of OH are reviewed. The various aspects of OH assessment are extensively discussed. Considerable discrepancies exist between the published guidelines regarding the methodology of OH diagnosing. We propose an algorithm for OH evaluation and a standardized protocol for bedside determination of OH by healthcare providers.
CONCLUSIONS
Correct assessment of OH is essential for its accurate diagnosis. The methodology of OH evaluation has not been sufficiently standardized. We emphasize the clinical importance of the uniform investigation of OH, according to the current guidelines for OH definition and meaning.
Topics: Algorithms; Diagnostic Techniques and Procedures; Humans; Hypotension, Orthostatic; Point-of-Care Testing
PubMed: 30982364
DOI: 10.1080/08037051.2019.1604067 -
PM & R : the Journal of Injury,... Sep 2018Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory... (Review)
Review
Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory pathways disrupts supraspinal control of blood pressure (BP). A common clinical consequence of cardiovascular dysfunction after SCI is orthostatic hypotension (OH), a debilitating condition characterized by rapid profound decreases in BP when assuming an upright posture. OH can result in a diverse array of insidious and pernicious health consequences. Acute effects of OH include decreased cardiac filling, cerebral hypoperfusion, and associated presyncopal symptoms such as lightheadedness and dizziness. Over the long term, repetitive exposure to OH is associated with a drastically increased prevalence of heart attack and stroke, which are leading causes of death in those with SCI. Current recommendations for managing BP after SCI primarily include pharmacologic interventions with prolonged time to effect. Because most episodes of OH occur in less than 3 minutes, this delay in action often renders most pharmacologic interventions ineffective. New innovative technologies such as epidural and transcutaneous spinal cord stimulation are being explored to solve this problem. It might be possible to electrically stimulate sympathetic circuitry caudal to the injury and elicit rapid modulation of BP to manage OH. This review describes autonomic control of the cardiovascular system before injury, resulting cardiovascular consequences after SCI such as OH, and the clinical assessment tools for evaluating autonomic dysfunction after SCI. In addition, current approaches for clinically managing OH are outlined, and new promising interventions are described for managing this condition.
Topics: Autonomic Nervous System; Disease Management; Humans; Hypotension, Orthostatic; Spinal Cord Injuries
PubMed: 30269810
DOI: 10.1016/j.pmrj.2018.04.011 -
Journal of Neurology Sep 2013Neurogenic orthostatic hypotension is a distinctive and treatable sign of cardiovascular autonomic dysfunction. It is caused by failure of noradrenergic... (Review)
Review
Neurogenic orthostatic hypotension is a distinctive and treatable sign of cardiovascular autonomic dysfunction. It is caused by failure of noradrenergic neurotransmission that is associated with a range of primary or secondary autonomic disorders, including pure autonomic failure, Parkinson's disease with autonomic failure, multiple system atrophy as well as diabetic and nondiabetic autonomic neuropathies. Neurogenic orthostatic hypotension is commonly accompanied by autonomic dysregulation involving other organ systems such as the bowel and the bladder. In the present review, we provide an overview of the clinical presentation, pathophysiology, epidemiology, evaluation and management of neurogenic orthostatic hypotension focusing on neurodegenerative disorders.
Topics: Humans; Hypotension, Orthostatic; Nervous System Diseases
PubMed: 23180176
DOI: 10.1007/s00415-012-6736-7 -
Drugs & Aging 2001Orthostatic hypotension is common in elderly patients, and is now considered to be an important prognostic factor for cognitive decline and mortality. In patients with... (Review)
Review
Orthostatic hypotension is common in elderly patients, and is now considered to be an important prognostic factor for cognitive decline and mortality. In patients with Parkinson's disease, the prevalence of symptomatic orthostatic hypotension may be as high as 20%. Two factors could explain this high prevalence. First, dopaminergic drugs may induce or worsen orthostatic hypotension. Secondly, Parkinson's disease is a cause of primary autonomic failure with an involvement of the peripheral autonomic system as shown by the ubiquitous distribution of Lewy bodies and reduced iobenguane [metaiodobenzylguanidine (MIBG)] cardiac uptake. These pathological and pharmacological characteristics clearly differentiate autonomic failure of Parkinson's disease from multiple system atrophy. If autonomic abnormalities appear to be present from the first stage of the disease, early onset (within the first year) of symptomatic orthostatic hypotension in the course of parkinsonism can be considered as an exclusion criteria for idiopathic Parkinson's disease. No specific clinical trials have evaluated the effects of antihypotensive drugs in patients with Parkinson's disease and thus no specific therapeutic strategy can be recommended. The management of orthostatic hypotension in patients with Parkinson's disease should always start with patient education and nonpharmacological treatment. Drug therapy should be reserved for symptomatic patients who do not get benefit from nonpharmacological management. Among the available drugs, alpha1-adrenergic agonists (mainly midodrine) or plasma volume expanders (mainly fludrocortisone) are the most frequently used. There are also some drugs that are currently investigational such as yohimbine and droxidopa. Other drugs such as desmopressin or octreotide may be of interest in some situations. Domperidone is widely used in patients with parkinsonism with no proven effect on orthostatic hypotension.
Topics: Blood Volume; Humans; Hypotension, Orthostatic; Parkinson Disease; Postprandial Period; Receptors, Adrenergic, alpha-1; Yohimbine
PubMed: 11482743
DOI: 10.2165/00002512-200118070-00003 -
Geriatrie Et Psychologie... Dec 2022Orthostatic hypotension is a frequent pathology especially in older adults and inhospital patients. Prevalence is increasing with age, and is about 30 % of patients...
Orthostatic hypotension is a frequent pathology especially in older adults and inhospital patients. Prevalence is increasing with age, and is about 30 % of patients older than 65 years. Orthostatic hypotension is defined as a fall in blood pressure of at least 20 mmHg systolic or 10 mmHg diastolic when standing or during head-up tilt testing. Orthostatic hypotension is significantly associated with several adverse outcomes such as falls, neurodegenerative disease, cardiovascular outcomes (such as stroke or heart failure), and mortality. Different mechanisms may be involved in pathogeny especially medications. Etiological work up will evaluate cardiac response when standing. Neurogenic orthostatic hypotension is characterized by a cardiovascular autonomic failure due to central or peripheral nervous system disorders. Non-neurogenic orthostatic hypotension is primarily caused by hypovolemia. Therapeutic management is based on non-pharmacological therapies, especially legs venous compression, even if evidence for effectiveness is lacking. Pharmacological therapies may be necessary for neurogenic orthostatic hypotension.
Topics: Humans; Aged; Hypotension, Orthostatic; Neurodegenerative Diseases; Blood Pressure
PubMed: 36700435
DOI: 10.1684/pnv.2022.1063 -
American Family Physician Sep 2011
Topics: Blood Pressure; Exercise Therapy; Humans; Hypotension, Orthostatic; Posture; Sodium, Dietary; Stockings, Compression
PubMed: 21888304
DOI: No ID Found -
Neurological Sciences : Official... Nov 2015Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be... (Review)
Review
Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be the most common symptom of OH. However, recent studies have demonstrated that 30-39 % of patients with OH experienced rotatory vertigo during upright posture (i.e., orthostatic vertigo, OV), which challenges the dogma that OH induces dizziness and not vertigo. A recent population-based study on spontaneously occurring OD across a wide age range showed that the one-year and lifetime prevalence of OD was 10.9 and 12.5 %, respectively. Approximately 83 % of patients with OD had at least one abnormal autonomic function test result. So far, 11 subtypes of OD have been proposed according to the pattern of autonomic dysfunction, and generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions was the most common type. Four different patterns of OH, such as classic, delayed, early, and transient type have been found in patients with OD. The head-up tilt test and Valsalva maneuver should be performed for a comprehensive evaluation of sympathetic adrenergic failure in patients with OD/OV. This review summarizes current advances in OH presenting OD/OV, with a particular focus on the autonomic dysfunction associated with OD.
Topics: Dizziness; Humans; Hypotension, Orthostatic; Vertigo
PubMed: 26292788
DOI: 10.1007/s10072-015-2363-2 -
Archives of Internal Medicine May 1992
Topics: Humans; Hypotension, Orthostatic; Time Factors
PubMed: 1580714
DOI: No ID Found