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Clinical Autonomic Research : Official... Mar 2008Orthostatic hypotension (OH) 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. The... (Review)
Review
Orthostatic hypotension (OH) 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. The prevalence of OH increases with age, with disorders that affect autonomic nerve transmission, and with increasingly severe orthostatic stress. In normal elderly subjects, the prevalence of OH is reported to be between 5 and 30%. The actual prevalence depends on the conditions during diagnostic testing, such as the frequency of blood pressure recordings, the time of day and the degree of orthostatic stress. Elderly subjects are often taking medications, such as antihypertensives and diuretics that can cause or aggravate OH. Neurological diseases such as diabetic neuropathy, Parkinson's disease, multiple system atrophy and the autonomic neuropathies further increase the likelihood of OH. The development of OH in normal subjects is associated with an increased mortality rate. OH in diabetes is also associated with a significant increase in mortality rate.
Topics: Age Factors; Blood Pressure; Humans; Hypotension, Orthostatic; Mortality; Prevalence
PubMed: 18368301
DOI: 10.1007/s10286-007-1001-3 -
American Family Physician Jun 1988Orthostatic hypotension is a potentially debilitating condition in the elderly. It may be associated with aging, drug therapy or underlying disease. Pathophysiologic... (Review)
Review
Orthostatic hypotension is a potentially debilitating condition in the elderly. It may be associated with aging, drug therapy or underlying disease. Pathophysiologic mechanisms can be classified as vasovagal, sympathicotonic and asympathicotonic (autonomic nervous system disease). Only a detailed history will uncover the disorder in some patients. When conservative measures fail, fludrocortisone is a generally helpful drug that induces volume expansion.
Topics: Aged; Humans; Hypotension, Orthostatic
PubMed: 3289336
DOI: No ID Found -
Current Opinion in Pharmacology Dec 2002Orthostatic hypotension (OH) is a fall in blood pressure after assuming an upright position. Whereas asymptomatic patients usually need no treatment, the majority of... (Review)
Review
Orthostatic hypotension (OH) is a fall in blood pressure after assuming an upright position. Whereas asymptomatic patients usually need no treatment, the majority of symptomatic patients can be cured by avoidance of trigger mechanisms and the use of physical countermaneuvers and non-pharmacological interventions. Several pharmacological therapies are available and generally fludrocortisone and midodrine are the drugs of first choice. Recently, highly individualized therapy with ambulatory norepinephrine therapy was able to mobilize otherwise immobile patients.
Topics: Cardiovascular Agents; Humans; Hypotension, Orthostatic; Posture
PubMed: 12482740
DOI: 10.1016/s1471-4892(02)00213-8 -
Current Therapy in Endocrinology and... 1997
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Revista de Neurologia Mar 2013Orthostatic hypotension (OH) is defined as a decrease in systolic blood pressure of 20 mmHg, or a decrease in diastolic blood pressure of 10 mmHg within three minutes of... (Review)
Review
Orthostatic hypotension (OH) is defined as a decrease in systolic blood pressure of 20 mmHg, or a decrease in diastolic blood pressure of 10 mmHg within three minutes of standing. It results from an inadequate response to postural changes in blood pressure. Common symptoms include dizziness, light-headedness, blurred vision, weakness, fatigue, nausea, palpitations, sweating, head and neck ache, slow cognitive performance and transient loss of conscientiousness. OH is a common problem among elderly patients and its aetiology is diverse, including autonomic nervous system dysfunction, cardiac problems, medication side effects, ageing changes or transitory deregulation of blood volume. The instrumental diagnosis can be easily accomplished by the tilt-table test, with continuous monitoring of blood pressure and cardiac parameters. It is a non-invasive technique and needs minimal collaboration from the patient. In our experience, when reviewing 327 patients, aged over 40 years and examined because of clinical suspicion of OH, the prevalence thereof was 51% whereas if focused in subjects older than 70, OH was proven in 90% of the cases. The older the patients, the more frequently they presented general deterioration, neurological or cardiac problems as well as pharmacological side effects. Ruling out neurological or cardiac malfunction can drastically improve the prognosis with possible reversibility of symptoms. Some nonpharmacological and pharmacological approaches to improve management of OH and life quality are described for guidance.
Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Autonomic Nervous System Diseases; Cardiovascular Diseases; Central Nervous System Stimulants; Dehydration; Diagnostic Techniques, Neurological; Fludrocortisone; Fluid Therapy; Humans; Hypotension, Orthostatic; Metabolic Diseases; Middle Aged; Stockings, Compression; Sympathomimetics; Vasopressins
PubMed: 23483469
DOI: No ID Found -
Circulation Jan 2009
Review
Topics: Algorithms; Autonomic Nervous System Diseases; Humans; Hypotension, Orthostatic; Norepinephrine; Prevalence
PubMed: 19124673
DOI: 10.1161/CIRCULATIONAHA.108.805887 -
Practical Neurology Apr 2015Orthostatic hypotension is common in Parkinson's disease. The current recommended management of orthostatic hypotension related to Parkinson's disease involves first... (Review)
Review
Orthostatic hypotension is common in Parkinson's disease. The current recommended management of orthostatic hypotension related to Parkinson's disease involves first general measures and then medications with little risk of severe adverse side effects.
Topics: Disease Management; Humans; Hypotension, Orthostatic; Parkinson Disease
PubMed: 25489118
DOI: 10.1136/practneurol-2014-001000 -
Current Hypertension Reports Mar 2022Patients with neurogenic orthostatic hypotension (OH) frequently have hypertension in the supine position (sHTN). We review the controversies surrounding the need and... (Review)
Review
PURPOSE OF REVIEW
Patients with neurogenic orthostatic hypotension (OH) frequently have hypertension in the supine position (sHTN). We review the controversies surrounding the need and safety of treating sHTN in patients with OH.
RECENT FINDINGS
The presence of sHTN complicates the management of OH because treatment of one can worsen the other. New approaches have been developed to treat OH without worsening sHTN by preferentially improving standing blood pressure, such as medications that harness the patient's residual sympathetic tone like pyridostigmine and atomoxetine, and devices such as an automated abdominal binder that targets the inappropriate splanchnic venous pooling causing OH. There is a reluctance to treat sHTN for fear of increasing the risks of falls and syncope associated with OH, thought to be more immediate and dangerous than the late complications of organ damage associated with sHTN. This, however, does not take into account that nighttime sHTN induces natriuresis, volume loss, and begets daytime orthostatic hypotension. It is possible to treat sHTN in ways that reduce the risk of worsening OH. Furthermore, novel approaches, such as the use of local heat can control nighttime sHTN, reduce nocturia, and improve OH. Although continued progress is needed, recent findings offer hope that we can treat nocturnal sHTN and at the same time improve daytime OH, lessening the controversy whether to treat or not sHTN.
Topics: Humans; Hypertension; Hypotension, Orthostatic
PubMed: 35230654
DOI: 10.1007/s11906-022-01168-7 -
CNS Drugs Aug 2011Orthostatic hypotension is a common adverse effect of antipsychotics that may delay or prevent titration to a dose necessary to control psychotic symptoms. Complications... (Review)
Review
Orthostatic hypotension is a common adverse effect of antipsychotics that may delay or prevent titration to a dose necessary to control psychotic symptoms. Complications of orthostatic hypotension include syncope, transient ischaemic attack, stroke, myocardial infarction and death. The risk of orthostatic hypotension associated with antipsychotic therapy is increased in patients with disorders of the autonomic nervous system, fluid imbalance and those taking concomitant drug therapy that affects haemodynamic tone. Prospective monitoring for changes in postural blood pressure is important because patients with psychotic disorders often do not articulate symptoms of orthostasis and the subjective report of dizziness does not correlate well with orthostatic blood pressure changes. Nonpharmacological strategies and patient education, most notably, slowly rising from the supine position, are crucial first steps in the prevention and treatment of both symptomatic and asymptomatic orthostatic hypotension. Pharmacological treatment is only recommended when symptomatic orthostatic hypotension persists despite proper nonpharmacological therapy and there is a compelling indication for antipsychotic treatment. Fludrocortisone is a reasonable first choice for symptomatic orthostatic hypotension. Other agents including desmopressin and midodrine may be considered in patients who do not respond favourably to a trial of fludrocortisone, but safety concerns and lack of evidence limit the utility of these agents.
Topics: Antipsychotic Agents; Blood Pressure; Drug Interactions; Drug Monitoring; Humans; Hypotension, Orthostatic; Psychotic Disorders; Risk Factors
PubMed: 21790209
DOI: 10.2165/11591710-000000000-00000 -
Current Hypertension Reviews 2023The prevalence of supine and nocturnal hypertension (S-N-HT) is high among patients with orthostatic hypotension (OH), especially in those who have a neurogenic... (Review)
Review
The prevalence of supine and nocturnal hypertension (S-N-HT) is high among patients with orthostatic hypotension (OH), especially in those who have a neurogenic aetiology. The evidence suggests that S-N-HT exacerbates OH, although it is unclear whether pharmacologic treatment of S-N-HT will improve OH. S-N-HT has also been associated with target organ damage. Therefore, assessment and management of S-N-HT should be an integral part of managing OH, but it is often overlooked in clinical practice.
Topics: Humans; Hypotension, Orthostatic; Supine Position; Hypertension
PubMed: 36567279
DOI: 10.2174/1573402119666221222160649