Format

Send to

Choose Destination
J Neurol. 2017 Aug;264(8):1567-1582. doi: 10.1007/s00415-016-8375-x. Epub 2017 Jan 3.

The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension.

Author information

1
Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA. cgibbons@bidmc.harvard.edu.
2
National Parkinson Foundation, Miami, FL, USA.
3
Vanderbilt University Medical Center, Nashville, TN, USA.
4
Duke University Hospital and Central Carolina Hospital, Durham, NC, USA.
5
Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
6
Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA.
7
University of Toledo Medical Center, Toledo, OH, USA.
8
University of Florida College of Medicine, Gainesville, FL, USA.
9
Keck/USC School of Medicine, Los Angeles, CA, USA.
10
Mayo Clinic, Rochester, MN, USA.
11
Saint Louis University Hospital, St. Louis, MO, USA.
12
University of Calgary, Calgary, BC, Canada.
13
University of Texas Southwestern Medical Center, Dallas, TX, USA.
14
New York University Langone Medical Center, New York, NY, USA.

Abstract

Neurogenic orthostatic hypotension (nOH) is common in patients with neurodegenerative disorders such as Parkinson's disease, multiple system atrophy, pure autonomic failure, dementia with Lewy bodies, and peripheral neuropathies including amyloid or diabetic neuropathy. Due to the frequency of nOH in the aging population, clinicians need to be well informed about its diagnosis and management. To date, studies of nOH have used different outcome measures and various methods of diagnosis, thereby preventing the generation of evidence-based guidelines to direct clinicians towards 'best practices' when treating patients with nOH and associated supine hypertension. To address these issues, the American Autonomic Society and the National Parkinson Foundation initiated a project to develop a statement of recommendations beginning with a consensus panel meeting in Boston on November 7, 2015, with continued communications and contributions to the recommendations through October of 2016. This paper summarizes the panel members' discussions held during the initial meeting along with continued deliberations among the panel members and provides essential recommendations based upon best available evidence as well as expert opinion for the (1) screening, (2) diagnosis, (3) treatment of nOH, and (4) diagnosis and treatment of associated supine hypertension.

KEYWORDS:

Autonomic dysfunction; Droxidopa; Fludrocortisone; Midodrine; Neurogenic orthostatic hypotension; Supine hypertension

PMID:
28050656
PMCID:
PMC5533816
DOI:
10.1007/s00415-016-8375-x
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center