Management of Orthostatic Hypotension

Palma, Jose‐Alberto

doi:10.1212/con.0000000000000816

Cited by 44 publications

(52 citation statements)

References 94 publications

(120 reference statements)

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“…Fludrocortisone is a synthetic mineralocorticoid that enhances sodium reabsorption in distal renal tubules leading to increase in intravascular volume and rise in blood pressure [8,9]. In addition, Davies et al [10] have shown that it may augment the sensitivity to the pressor effect of noradrenaline.…”

Section: Use Of Fludrocortisone For Treatment Of Intradialytic Hypotensionmentioning

confidence: 99%

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

Mikhail¹

2021

IJCEMR

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Background: Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD). Pharmacologic treatment options are limited in terms of number and efficacy. Objective: To report a case of IDH that responded to fludrocortisone. Similar cases and pertinent literature were reviewed. Methods: Pubmed research of English literature up to June 16, 2021. Search terms included, hemodialysis, hypotension, intradialytic hypotension, midodrine, fludrocortisone, droxidopa, safety, efficacy. Retrospective studies, case report and series, Cochrane reviews, randomized trials are reviewed. Results: Midodrine and droxidopa are approved by the Federal Drug Administration (FDA) for treatment of orthostatic hypotension, but not for IDH. No randomized trials are available to evaluate midodrine for IDH. One large retrospective study suggests that midodrine use for treatment of IDH may be associated with increase death and hospitalization. Results of a single randomized phase 2 trial suggest that droxidopa may not be effective in IDH. The author reports a 63-year-old patient with IDH who failed midodrine but responded to the addition of fludrocortisone. Review of literature revealed 3 other similar cases, No short-term adverse effects of fludrocortisone were reported in any of these 4 cases. Conclusions: Pharmacological options available for treatment of IDH are limited and inadequately studied. Fludrocortisone appears a promising agent to prevent IDH in patients failing midodrine. Randomized trials are needed to compare efficacy and safety of midodrine and fludrocortisone and their combination for management of IDH.

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Section: Use Of Fludrocortisone For Treatment Of Intradialytic Hypotensionmentioning

confidence: 99%

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

Mikhail¹

2021

IJCEMR

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“…Orthostatic hypotension often occurs when one's position changes rapidly, and it may result in several symptoms, such as headache, blurred vision, and dizziness [ 18 ]. A change from a horizontal to a vertical posture shifts one's center of gravity.…”

Section: Introductionmentioning

confidence: 99%

Postural Changes on Heart Rate Variability among Older Population: A Preliminary Study

Chuangchai

Pothisiri

2021

Current Gerontology and Geriatrics Research

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Objective. This study aims to investigate an association between body postures and autonomic nervous system (ANS) responses through analysis of short-term heart rate variability (HRV) data obtained through electrocardiography. Methods. Forty older individuals were recruited to form the sample. HRV measurements were taken in three positions—sitting, supine, and standing—and compared. Results. Results demonstrated statistically significant differences in the HRV parameters used to examine the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS), specifically in the measurements obtained from the sitting position and the supine position ( P < 0.001 for PNS and P = 0.011 for SNS). The differences in these parameters were, however, negligible between the sitting and the standing positions. Moreover, the ANS responses obtained in the sitting position were strongly and positively correlated with those in the standing position (r = 0.854 for PNS and r = 0.794 for SNS). These results suggested that the PNS and SNS parameters obtained while sitting were likely to be affected by orthostatic hypotension in much the same way as those in the standing position, as compared to the supine position. Conclusions. As such, sitting may not be the best position for older individuals in the assessment of their autonomic responses, whereas the supine position is recommended as the baseline posture in the old-age population. These findings are useful for future research in clinical settings that require accuracy in the ANS responses as determined by the HRV measurements.

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“…Postoperative OH is often characterized by symptoms of syncope, dizziness, and light headedness. However, weakness, fatigue, cognitive issues, visual blurring, headache, neck pain, orthostatic dyspnea, or chest pain caused by OH may also occur in some patients and make patients distressed, potentially delaying recovery after surgery (4,5). An association between OH and many types of surgeries, including cervical spine surgery, has been reported (3,6,7).…”

Section: Introductionmentioning

confidence: 99%

Orthostatic Hypotension Following Posterior Spinal Fusion Surgeries for Spinal Deformity Correction in Adolescents: Prevalence and Risk Factors

Yang

Chen

Tong

et al. 2021

Preprint

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Study Design: Retrospective case series.Objectives: This study aimed to determine the prevalence and risk factors for orthostatic hypotension (OH) in adolescents undergoing posterior spinal fusion for spinal deformity correction.Methods: The data of 312 consecutive adolescents who underwent posterior spinal fusion for spinal deformity correction in our center over 12 months were retrieved. Patient characteristics, including whether laminectomy or osteotomy was performed during the surgery, the occurrence of postoperative nausea and vomiting (PONV), perioperative hemoglobin albumin changes, perioperative blood transfusion, length of bed rest, willingness to ambulate, length of postoperative exercises of the lower limbs, and length of hospital stay, were collected and compared statistically between patients who did and did not develop postoperative OH.Results: Of 312 patients, 225 (72.1%) developed OH postoperatively, and all cases completely resolved 5 days after the first out-of-bed exercises. Significant differences in BMI, the incidence of PONV, the willingness to ambulate and the length of postoperative exercises of the lower limbs were observed. The mean length of hospital stay of the patients with OH was longer than that of the patients without OH.Conclusion: Our study suggests that temporary OH is a common manifestation following posterior spinal fusion for spinal deformity correction in adolescents. Postoperative OH may increase the length of hospital stay in these patients. Patients with PONV, who are not willing to ambulate and who perform postoperative lower limb exercises for a shorter time are more likely to have OH.

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Management of Orthostatic Hypotension

Cited by 44 publications

References 94 publications

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

Postural Changes on Heart Rate Variability among Older Population: A Preliminary Study

Orthostatic Hypotension Following Posterior Spinal Fusion Surgeries for Spinal Deformity Correction in Adolescents: Prevalence and Risk Factors

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