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Journal of Hypertension. Supplement :... Dec 1991Orthostatic hypotension has a number of causes, many of which are easily reversible. However, characteristics such as standing hypotension in conjunction with supine... (Review)
Review
Orthostatic hypotension has a number of causes, many of which are easily reversible. However, characteristics such as standing hypotension in conjunction with supine hypertension are not always easily detected in the clinic or office setting. Ambulatory blood pressure monitoring may be a valuable technique for diagnosis and for the assessment of therapeutic effects in patients with orthostatic hypotension.
Topics: Aged; Blood Pressure; Blood Pressure Monitors; Circadian Rhythm; Fludrocortisone; Humans; Hypertension; Hypotension, Orthostatic; Posture
PubMed: 1795212
DOI: No ID Found -
Cardiovascular & Hematological... Mar 2007Orthostatic hypotension (OH) may be dependent upon various neurogenic and non-neurogenic disorders and conditions. Neurogenic causes include the main autonomic failure... (Review)
Review
Orthostatic hypotension (OH) may be dependent upon various neurogenic and non-neurogenic disorders and conditions. Neurogenic causes include the main autonomic failure syndromes, primary (multiple system atrophy, pure autonomic failure, and autonomic failure associated with Parkinson's disease) and secondary (central nervous system diseases, peripheral neuropathies and systemic diseases). Non-neurogenic causes of OH include cardiac impairment, fluid and electrolyte loss, vasodilatation, and old age. A number of drugs may also cause OH, through their vasoactive action or by interfering with the autonomic nervous system. Symptoms of OH are debilitating, often confining patients to bed, and longitudinal studies have shown that OH increases the risk of stroke, myocardial ischemia and mortality. The therapeutic goal is to decrease the incidence and severity of postural symptoms, rather than restore normotension. In non-neurogenic OH, treatment of the underlying cause may be curative. In neurogenic OH a combination of non-pharmacological and pharmacological measures is often needed. Patient education and non-pharmacological measures represent the first step; among these interventions, fluid repletion and physical countermanoeuvres have been proven very effective. Pharmacological treatment comprises a number of agents acting on blood vessels, on blood volume or with other pressor mechanisms. The drugs most currently used are fludrocortisone and midodrine. Fludrocortisone expands the extravascular body fluid volume and improves alpha-adrenergic sensitivity. Midodrine is a peripheral, selective alpha1-adrenergic agonist that causes arterial and venous vasoconstriction. Despite the wide use of these drugs, multicentre, randomised and controlled studies for the treatment of OH are still scarce and limited to few agents and groups of patients. Pharmacological management of OH substantially improves the quality of life of patients, although it may be problematic. The development of supine hypertension and subsequent congestive heart failure should be avoided, especially in those patients with a pre-existing cardiovascular risk, such as in diabetes or ischemic heart disease.
Topics: Adrenergic alpha-Agonists; Animals; Anti-Inflammatory Agents; Autonomic Nervous System; Fludrocortisone; Humans; Hypotension, Orthostatic; Midodrine
PubMed: 17346129
DOI: 10.2174/187152907780059029 -
Archives of Physical Medicine and... Feb 2015To systematically review the literature on nonpharmacologic treatment of orthostatic hypotension. (Review)
Review
OBJECTIVE
To systematically review the literature on nonpharmacologic treatment of orthostatic hypotension.
DATA SOURCES
MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials, and SPORTDiscus were searched for human studies written in the English language between January 1980 and April 2013. Reference lists of relevant articles were reviewed for citations to expand the data set.
STUDY SELECTION
Prospective experimental studies assessing nonpharmacologic interventions for management of orthostatic drop in blood pressure in various patient populations were included. All studies identified through the literature search were reviewed independently in duplicate. Of the 642 studies, 23 met the selection criteria.
DATA EXTRACTION
Two reviewers independently extracted data for analysis, including systolic and diastolic blood pressure and orthostatic symptoms in response to postural challenge before and after the intervention. All 23 studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database scale for randomized controlled trials and the Downs and Black tool for nonrandomized trials.
DATA SYNTHESIS
There were 8 identified nonpharmacologic interventions for management of orthostatic hypotension under 2 general categories: physical modalities (exercise, functional electrical stimulation, compression, physical countermaneuvers, compression with physical countermaneuvers, sleeping with head up) and dietary measures (water intake, meals). Owing to the clinically diverse nature of the studies, statistical comparison (meta-analysis) was deemed inappropriate. Instead, descriptive comparisons were drawn. Levels of evidence were assigned.
CONCLUSIONS
Strong levels of evidence were found for 4 of the 8 interventions: functional electrical stimulation in spinal cord injury, compression of the legs and/or abdomen, physical countermaneuvers in various patient populations, and eating smaller and more frequent meals in chronic autonomic failure. However, this conclusion is based on a limited number of studies with small sample sizes. Further research into all interventions is warranted.
Topics: Compression Bandages; Drinking Behavior; Electric Stimulation Therapy; Exercise; Humans; Hypotension, Orthostatic; Meals; Muscle Contraction; Posture
PubMed: 25449193
DOI: 10.1016/j.apmr.2014.09.028 -
Clinical Autonomic Research : Official... Feb 2024
Review
Topics: Humans; Synucleinopathies; Hypotension, Orthostatic; Parkinson Disease; Lewy Body Disease; Multiple System Atrophy; alpha-Synuclein
PubMed: 38079008
DOI: 10.1007/s10286-023-01006-z -
Pacing and Clinical Electrophysiology :... Apr 2003
Review
Topics: Humans; Hypotension, Orthostatic; Syncope
PubMed: 12715851
DOI: 10.1046/j.1460-9592.2003.t01-1-00155.x -
Current Problems in Cardiology Feb 2023Supine hypertension-orthostatic hypotension disease poses a management challenge to clinicians. Data on short term outcomes of patients with orthostatic hypotension (OH)... (Review)
Review
Supine hypertension-orthostatic hypotension disease poses a management challenge to clinicians. Data on short term outcomes of patients with orthostatic hypotension (OH) who are hospitalized with hypertensive (HTN) crises is lacking. The Nationwide Readmission Database 2016-2019 was queried for all hospitalizations of HTN crises. Hospitalizations were stratified according to whether OH was present or not. We employed propensity score to match hospitalizations for patients with OH to those without, at 1:1 ratio. Outcomes evaluated were 30-days readmission with HTN crises or falls, as well as hospital outcomes of in-hospital mortality, acute kidney injury, acute congestive heart failure, acute coronary syndrome, type 2 myocardial infarction, aortic dissection, stroke, length of stay (LOS), discharge to nursing home and hospitalization costs. We included a total of 9451 hospitalization (4735 in the OH group vs 4716 in the control group). OH group was more likely to be readmitted with falls (Odds ratio [OR]:3.27, P < 0.01) but not with HTN crises (P = 0.05). Both groups had similar likelihood of developing acute kidney injury (P = 0.08), stroke/transient ischemic attack (P = 0.52), and aortic dissection (P = 0.66). Alternatively, OH group were less likely to develop acute heart failure (OR:0.54, P < 0.01) or acute coronary syndrome (OR:0.39, P < 0.01) in the setting of HTN crises than non-OH group. OH group were more likely to have longer LOS and have higher hospitalization costs. Patients with OH who are admitted with HTN crises tend to have similar or lower HTN-related complications to non-OH group while having higher likelihood of readmission with falls, LOS and hospitalization costs. Further studies are needed to confirm such findings.
Topics: Humans; Hypotension, Orthostatic; Acute Coronary Syndrome; Hospitalization; Stroke; Heart Failure; Aortic Dissection
PubMed: 36280124
DOI: 10.1016/j.cpcardiol.2022.101455 -
Neurology Apr 1995Blood pressure homeostasis is particularly challenged by moving to an upright position. The autonomic nervous system, structural factors, infravascular volume, and... (Review)
Review
Blood pressure homeostasis is particularly challenged by moving to an upright position. The autonomic nervous system, structural factors, infravascular volume, and circulating and local hormones influence the body's response to a change in posture. Disorders of the autonomic nervous system can result in orthostatic hypotension. Both neurogenic and nonneurogenic disorders can contribute, and distinguishing between the two causes is important for both diagnosis and management. It is also important to recognize various factors in daily life that influence orthostatic hypotension.
Topics: Hemodynamics; Humans; Hypotension, Orthostatic
PubMed: 7746371
DOI: No ID Found -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2023Orthostatic hypotension (OH) is a common vegetative symptom of Parkinson's disease (PD), which is predominantly neurogenic in nature. Detection and treatment of OH is of...
Orthostatic hypotension (OH) is a common vegetative symptom of Parkinson's disease (PD), which is predominantly neurogenic in nature. Detection and treatment of OH is of great importance, since it affects daily activity and increases the risk of falls. In the long term it damages target organs - the heart, kidneys and brain. In this regard, the review discusses the issues of classification, pathogenesis of OH, stages of diagnosis and correction of blood pressure, as well as measures for lifestyle changing, non-drug and drug treatment of orthostasis. Strategies for the management of patients with postprandial hypotension, hypertension in the supine position and nocturnal hypertension are considered separately. Despite modern combined methods of treatment, the burden of OH in patients with PD remains heavy, and fluctuations in blood pressure due to concomitant hypertension in the supine position are a significant problem. This highlights the need to initiate scientific research and new therapeutic approaches.
Topics: Humans; Hypotension, Orthostatic; Parkinson Disease; Orthostatic Intolerance; Patients; Hypertension
PubMed: 37382973
DOI: 10.17116/jnevro202312306116 -
Spinal Cord Jun 2006Motor and sensory deficits are well-known consequences of spinal cord injury (SCI). During the last decade, a significant number of experimental and clinical studies... (Review)
Review
Motor and sensory deficits are well-known consequences of spinal cord injury (SCI). During the last decade, a significant number of experimental and clinical studies have focused on the investigation of autonomic dysfunction and cardiovascular control following SCI. Numerous clinical reports have suggested that unstable blood pressure control in individuals with SCI could be responsible for their increased cardiovascular mortality. The aim of this review is to outline the incidence and pathophysiological mechanisms underlying the orthostatic hypotension that commonly occurs following SCI. We describe the clinical abnormalities of blood pressure control following SCI, with particular emphasis upon orthostatic hypotension. Possible mechanisms underlying orthostatic hypotension in SCI, such as changes in sympathetic activity, altered baroreflex function, the lack of skeletal muscle pumping activity, cardiovascular deconditioning and altered salt and water balance will be discussed. Possible alterations in cerebral autoregulation following SCI, and the impact of these changes upon cerebral perfusion are also examined. Finally, the management of orthostatic hypotension will be considered.
Topics: Baroreflex; Blood Pressure; Heart; Humans; Hypotension, Orthostatic; Spinal Cord; Spinal Cord Injuries
PubMed: 16304564
DOI: 10.1038/sj.sc.3101855 -
Autonomic Neuroscience : Basic &... Sep 2020Neurogenic orthostatic hypotension (nOH) is a common comorbidity in patients with neurodegenerative diseases. It is associated with an increased risk of falls, incident... (Review)
Review
Neurogenic orthostatic hypotension (nOH) is a common comorbidity in patients with neurodegenerative diseases. It is associated with an increased risk of falls, incident cardiovascular disease, and all-cause mortality. There are over 5 million individuals in the U.S. with heart failure (HF) with an associated 50% mortality rate at 5 years. The prevalence of nOH and HF increase with age and, as the population continues to age, will be increasingly common comorbid conditions. Thus, the effective management of these conditions has important implications for public health. The management of orthostatic hypotension in the context of congestive heart failure is challenging due to the fact that the fundamental principles of management of these disease states are in opposition to each other. In this review, we will discuss the principles of management of nOH and HF and outline strategies for the effective treatment of these comorbid conditions.
Topics: Aged; Comorbidity; Heart Failure; Humans; Hypotension, Orthostatic; Male
PubMed: 32559655
DOI: 10.1016/j.autneu.2020.102691