Treatment of Neurogenic Orthostatic Hypotension

Abstract

Orthostatic blood pressure dysregulation is common among older people owing to the aging process itself as well as to dysautonomia due to comorbidities such as Parkinson's disease, cardiovascular diseases (CVD) or diabetes, and the use of medication (such as antihypertensive agents and benzodiazepines).The most often studied orthostatic blood pressure dysregulation is orthostatic hypotension, which is identified in approximately 20-30% of individuals over 65 years of age 1,2 and is associated with an increase CVD unrelated mortality. [3][4][5][6] Extensive research has also tended (with some exceptions) to support a role for orthostatic hypotension as a risk factor for CVD in the elderly. 7-9 On the contrary orthostatic hypertension, has been less thoroughly analyzed. 10 It seems to affect about 10% of older people, but its reported prevalence varies because different criteria have been adopted to define it. 11 Recent researches point to orthostatic hypertension as an emerging hemodynamic cardiovascular risk factor, particularly in older people with essential hypertension. 10,12 The condition seems to be associated with more severe organ damage and a greater risk of clinical and subclinical CVD events. 11,12 To the best of our knowledge, no published data are available on the association between orthostatic hypertension and mortality.Based on these premises, we hypothesized that not only orthostatic hypotension, but also orthostatic hypertension may be associated to a higher risk of mortality. Orthostatic Changes in Blood Pressure BACKGROUNDAn extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people.