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J Am Coll Cardiol. 2018 Sep 11;72(11):1294-1309. doi: 10.1016/j.jacc.2018.05.079.

Orthostatic Hypotension: JACC State-of-the-Art Review.

Author information

1
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: rfreeman@bidmc.harvard.edu.
2
King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia.
3
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
4
Lotus Spine and Pain, San Antonio, Texas.
5
Department of Neurology, Stanford Medical Center, Palo Alto, California.

Abstract

Neurogenic orthostatic hypotension is a highly prevalent and disabling feature of autonomic failure due to both peripheral and central neurodegenerative diseases. Community-based epidemiological studies have demonstrated a high morbidity and mortality associated with neurogenic orthostatic hypotension. It is due to impairment of baroreflex-mediated vasoconstriction of the skeletal muscle and splanchnic circulation and is caused by damage or dysfunction at central and/or peripheral sites in the baroreflex efferent pathway. Nonpharmacological and pharmacological interventions may be implemented to ameliorate the symptoms of orthostatic intolerance and improve quality of life. Many patients will be adequately treated by education, counseling, removal of hypotensive medications, and other nonpharmacological interventions, whereas more severely afflicted patients require pharmacological interventions. The first stage of pharmacological treatment involves repletion of central blood volume. If unsuccessful, this should be followed by treatment with sympathomimetic agents.

KEYWORDS:

Parkinson disease; autonomic; baroreflex; blood pressure; diabetic neuropathies; sympathetic

PMID:
30190008
DOI:
10.1016/j.jacc.2018.05.079
[Indexed for MEDLINE]
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