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Expert Rev Cardiovasc Ther. 2015 Nov;13(11):1263-76. doi: 10.1586/14779072.2015.1095090. Epub 2015 Oct 1.

Orthostatic hypotension: managing a difficult problem.

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a 1 Department of Neurology, University of Texas Health Sciences Center, San Antonio, TX, USA.
b 2 Department of Cardiac Science, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.
c 3 Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee, USA.


Orthostatic hypotension (OH) leads to a significant number of hospitalizations each year, and is associated with significant morbidity and mortality among affected individuals. Given the increased risk for cardiovascular events and falls, it is important to identify the underlying etiology of OH and to choose appropriate therapeutic agents. OH can be non-neurogenic or neurogenic (arising from a central or peripheral lesion). The initial evaluation includes orthostatic vital signs, complete history and a physical examination. Patients should also be evaluated for concomitant symptoms of post-prandial hypotension and supine hypertension. Non-pharmacologic interventions are the first step for treatment of OH. The appropriate selection of medications can also help with symptomatic relief. This review highlights the pathophysiology, clinical features, diagnostic work-up and treatment of patients with neurogenic OH.


Parkinson’s disease; autonomic failure; autonomic nervous system; droxidopa; multiple system atrophy; orthostatic hypotension; orthostatic intolerance; peripheral neuropathy

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