Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension

  title={Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension},
  author={Peter Chisholm and Mahesan Anpalahan},
  journal={Internal Medicine Journal},
Both hypertension and orthostatic hypotension (OH) are strongly age‐associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well‐established treatments. Not infrequently, they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special… 

Review of management strategies for orthostatic hypotension in older people

In this review, the current evidence for existing and emerging treatments for OH is presented, and the management of supine hypertension associated with the treatment of OH in patients with autonomic failure is addressed.

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Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management.

Risk Factors for Orthostatic Hypotension: Differences Between Elderly Men and Women

Although the prevalence of OH is similar in both sexes, there are different risk factors associated by sex, and systolic BP ≥140 mm Hg was associated with increased risk of OH only with women while BMI was a protective factor for OH in men and women.

Inverted circadian variation of arterial pressure in a geriatric patient: an indicator of autonomic dysfunction

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Hypertension Management in the Elderly

This chapter highlights past and recent trials among elderly hypertensive patients and summarizes major current and emerging guideline considerations in the elderly population.

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High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans

This work has shown that use of medications that have the potential to induce OH, particularly concomitant use of several of such medications, is a major factor for the development of OH.

ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension

Recommendations on the treatment of orthostatic hypotension as reviewed by the American Society of Hypertension are provided and practical advice for clinicians on how to screen, diagnose, and treat patients using behavioral, nonpharmacologic, and pharmacologic strategies is provided.

Neurogenic orthostatic hypotension – management update and role of droxidopa

Management strategies for OH are presented, including the mechanism of action of droxidopa and various studies performed to assess its efficacy.

New Developments in the Management of Neurogenic Orthostatic Hypotension

Droxidopa was approved by the FDA in 2014 for the treatment of neurogenic OH associated with primary autonomic neuropathies including Parkinson disease, multiple system atrophy, and pure autonomic failure, in an attempt to provide a practical guide to its management.

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

The finding of lower plasma NE levels in patients with than without supine hypertension suggests involvement of pressor mechanisms independent of the sympathetic nervous system.

Pathophysiological basis of orthostatic hypotension in autonomic failure

Protective measures that reduce excessive orthostatic blood pooling have been developed and evaluated and suggest that the abdominal compartment and perhaps leg skin vasculature are the most likely candidates.

Diagnosis and Treatment of Supine Hypertension in Autonomic Failure Patients With Orthostatic Hypotension

The recent observation that patients with supine hypertension develop left ventricular hypertrophy suggests they should be treated and short‐acting vasodilators can be used during the night.

Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment.

EFNS guidelines on the diagnosis and management of orthostatic hypotension

Evidence based guidelines for the diagnostic workup and the therapeutic management (non‐pharmacological and pharmacological) are provided based on the EFNS guidance regulations.

Pyridostigmine in the Treatment of Postural Orthostatic Tachycardia: A Single‐Center Experience

A retrospective, single‐center, long‐term experience regarding the efficacy and adverse effect profile of pyridostigmine in the treatment of POTS patients is reported.