Clinical classification of orthostatic hypotensions

Cheshire, William P.

doi:10.1007/s10286-017-0414-x

Cited by 17 publications

(6 citation statements)

References 8 publications

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“…In patients with vasovagal syncope, prolonged tilt may reproduce an episode. 39,40 Not infrequently, patients may present with symptoms mimicking those of orthostatic hypotension but without an identified fall in blood pressure, including patients with vestibular disorders, gait abnormalities, CNS depression from alcohol and drug use, and "the inebriationlike syndrome" (in which patients with parkinsonism report feeling imbalanced and unsteady, as if they were slightly inebriated, but unrelated to alcohol intake). 41 Conversely, patients with cognitive impairment may not accurately identify symptoms of organ hypoperfusion, despite low blood pressure when standing.…”

Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Management of Orthostatic Hypotension

Palma¹

2020

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW:This article reviews the management of orthostatic hypotension with emphasis on neurogenic orthostatic hypotension.RECENT FINDINGS: Establishing whether the cause of orthostatic hypotension is a pathologic lesion in sympathetic neurons (ie, neurogenic orthostatic hypotension) or secondary to other medical causes (ie, non-neurogenic orthostatic hypotension) can be achieved by measuring blood pressure and heart rate at the bedside. Whereas fludrocortisone has been extensively used as firstline treatment in the past, it is associated with adverse events including renal and cardiac failure and increased risk of all-cause hospitalization. Distinguishing whether neurogenic orthostatic hypotension is caused by central or peripheral dysfunction has therapeutic implications. Patients with peripheral sympathetic denervation respond better to norepinephrine agonists/precursors such as droxidopa, whereas patients with central autonomic dysfunction respond better to norepinephrine reuptake inhibitors. SUMMARY:Management of orthostatic hypotension is aimed at improving quality of life and reducing symptoms rather than at normalizing blood pressure. Nonpharmacologic measures are the key to success. Pharmacologic options include volume expansion with fludrocortisone and sympathetic enhancement with midodrine, droxidopa, and norepinephrine reuptake inhibitors. Neurogenic supine hypertension complicates management of orthostatic hypotension and is primarily ameliorated by avoiding the supine position and sleeping with the head of the bed elevated.

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Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Management of Orthostatic Hypotension

Palma¹

2020

CONTINUUM: Lifelong Learning in Neurology

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“…Initial orthostatic hypotension (OH) is a clinical syndrome with a transient drop in blood pressure upon standing (by definition > 40 mmHg systolic or > 20 mmHg diastolic within 15 sec after standing up from supine position) [1]. This is different from classic OH which is defined by a sustained reduction of at least 20 mmHg in systolic or 10 mmHg in diastolic blood pressure within 3 min of standing [2]. The pathophysiological mechanisms leading to initial OH appear to differ from classic OH, as initial OH typically occurs upon active standing and not during passive tilting.…”

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confidence: 99%

Delayed recovery from initial orthostatic hypotension: an expression of frailty in the elderly

2020

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“…In general, the aetiology of OH is diverse and divided into nonneurogenic and neurogenic causes 3 . Herein, different causes of OH had different mechanisms for the impairment of SVR increase [18][19][20] . In nonneurogenic OH patients, SVR did not increase because of intravascular hypovolemia and consequently decreased CO, which was usually accompanied by compensatory tachycardia.…”

Section: Impaired Increase In Svrmentioning

confidence: 99%

Haemodynamic Characteristics And Factors Influencing The Head-Up Tilt Test In Patients With Orthostatic Hypotension

Wang¹,

Yueyang²,

Wang³

et al. 2021

Preprint

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Background: Failure to activate autonomic neural and hormonal reflex mechanisms could result in orthostatic hypotension. Patients with orthostatic hypotension often experience symptoms of cerebral hypoperfusion, including syncope. The purpose of this study was to investigate the haemodynamic characteristics of patients with orthostatic hypotension and the factors affecting blood pressure regulation.Methods: This retrospective study enrolled 45 patients who were diagnosed with typical orthostatic hypotension by the head-up tilt test at Beijing Tiantan Hospital, Capital Medical University from June 2019 to December 2020. Changes in haemodynamic parameters in these patients were compared in the supine and tilted upright positions.Results: For all patients, haemodynamic parameters in the supine and tilted upright positions were compared, and systolic blood pressure, diastolic blood pressure, mean blood pressure, cardiac output and stroke volume were all significantly decreased per minute. Heart rate significantly increased per minute, but systemic vascular resistance did not significantly change. The absolute value, percentage and rate of increases in heart rate and the absolute value, percentage and rate of decreases in stroke volume from the supine to the titled upright position were significantly lower in patients 60 years and older than in patients under 60 years old. Linear regression analyses found that the changes in heart rate, stroke volume and systemic vascular resistance were related to changes in systolic blood pressure, while the changes in stroke volume and systemic vascular resistance had more important effects on systolic blood pressure.Conclusions: In patients with orthostatic hypotension, we observed no significant increase in systemic vascular resistance from the supine position to the tilted upright position. Nevertheless, an increase in systemic vascular resistance had a significant impact on the maintenance of systolic blood pressure. In addition, in orthostatic hypotension patients younger than 60 years of age, heart rate increased while stroke volume decreased significantly after tilting upright compared with orthostatic hypotension patients older than 60 years of age and older.

show abstract

Clinical classification of orthostatic hypotensions

Cited by 17 publications

References 8 publications

Management of Orthostatic Hypotension

Management of Orthostatic Hypotension

Delayed recovery from initial orthostatic hypotension: an expression of frailty in the elderly

Haemodynamic Characteristics And Factors Influencing The Head-Up Tilt Test In Patients With Orthostatic Hypotension

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