Orthostatic hypotension : Diagnosis and therapy.

01:41 EDT 26th May 2015 | BioPortfolio

Summary of "Orthostatic hypotension : Diagnosis and therapy."

Syncope is a frequent clinical event in the general population and occurs in up to every second patient during their lifetime. Reflex syncope is the most prevalent mechanism and is often triggered by orthostatic stress. Orthostatic hypotension (OH) represents a rare cause in young patients but is an important differential diagnosis in the aged. The Framingham study revealed an increase in the incidence of OH-triggered syncope from 5.7 events/1000 person-years at the age of 60-69 to 11.1 in men who are 70-79 years of age. OH often constitutes a chronic, debilitating illness with significant reduction in the quality of life. Important causes are volume loss, side effects of different vasoactive drugs, and neurodegenerative or secondary autonomic diseases following long-standing diabetes or amyloid disease. OH is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and prevention of syncopal events. Drug therapy alone is never adequate. Because orthostatic stress varies during the day, a patient-tailored approach that emphasizes education and several general actions is recommended together with physical therapy and isometric exercise maneuvers. Moderate and severe cases require additional drug treatment to increase peripheral vascular resistance.


I. Medizinische Klinik, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland, rainer.schimpf@umm.de.

Journal Details

This article was published in the following journal.

Name: Herzschrittmachertherapie & Elektrophysiologie
ISSN: 1435-1544


PubMed Articles [15772 Associated PubMed Articles listed on BioPortfolio]

Therapeutic use of compression stockings for orthostatic hypotension: an assessment of patient and physician perspectives and practices.

elastic compression stockings (ECS) can be used as a non-pharmacological therapeutic option for older patients with orthostatic hypotension (OH). We aimed to investigate the practices and views of pat...

---Neurogenic Hyperadrenergic Orthostatic Hypotension - A Newly-recognized Variant of Orthostatic Hypotension in Older Adults with Elevated Norepinephrine.

Patients with neurogenic orthostatic hypotension (OH) typically have impaired sympathetic nervous system tone and therefore low levels of upright plasma norepinephrine. We report a subset of patients ...

Randomized Withdrawal Study of Patients With Symptomatic Neurogenic Orthostatic Hypotension Responsive to Droxidopa.

We evaluated whether droxidopa, a prodrug converted to norepinephrine, is beneficial in the treatment of symptomatic neurogenic orthostatic hypotension, which results from failure to generate an appro...

Efficacy of Atomoxetine Versus Midodrine for the Treatment of Orthostatic Hypotension in Autonomic Failure.

The clinical presentation of autonomic failure is orthostatic hypotension. Severely affected patients require pharmacological treatment to prevent presyncopal symptoms or frank syncope. We previously ...

Influence of nocturnal and daytime sleep on initial orthostatic hypotension.

The incidence of vasovagal syncope is more common in the morning. Previous researchers have reported negligible diurnal variation in the physiological responses associated with initial orthostatic hyp...

Clinical Trials [1815 Associated Clinical Trials listed on BioPortfolio]

Fipamezole in Neurogenic Orthostatic Hypotension

The purpose of this study is to determine whether Fipamezole is effective in the treatment of orthostatic hypotension and related symptoms in multiple system atrophy and Parkinson's diseas...

Is Orthostatic Hypotension Associated With Nondipping Hypertension

The aim of the study is to evaluate whether orthostatic hypotension is associated with nondipping hypertension. Methods and patients: 400 subjects who are referred for 24hABPM will be fil...

Phase II Study of Midodrine for Neurogenic Orthostatic Hypotension

OBJECTIVES: I. Study further the safety and efficacy of the alpha-receptor agonist midodrine in patients with neurogenic orthostatic hypotension. II. Assess the quality of life in these...

A Clinical Study for Patients With Neurogenic Orthostatic Hypotension (NOH) Using Droxidopa

The purpose of this study is to see whether droxidopa is effective in treating symptoms of neurogenic orthostatic hypotension in patients with Primary Autonomic Failure (Pure Autonomic Fai...

Open-Label Clinical Study of Droxidopa in Patients With Neurogenic Orthostatic Hypotension (NOH)

The purpose of this study is to see whether the durability of effect of Droxidopa in treating symptoms of neurogenic orthostatic hypotension in patients with Primary Autonomic Failure (Pur...

Medical and Biotech [MESH] Definitions

Symptoms of cerebral hypoperfusion or autonomic overaction which develop while the subject is standing, but are relieved on recumbency. Types of this include NEUROCARDIOGENIC SYNCOPE; POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME; and neurogenic ORTHOSTATIC HYPOTENSION. (From Noseworthy, JH., Neurological Therapeutics Principles and Practice, 2007, p2575-2576)

A significant drop in BLOOD PRESSURE after assuming a standing position. Orthostatic hypotension is a finding, and defined as a 20-mm Hg decrease in systolic pressure or a 10-mm Hg decrease in diastolic pressure 3 minutes after the person has risen from supine to standing. Symptoms generally include DIZZINESS, blurred vision, and SYNCOPE.

A syndrome of ORTHOSTATIC INTOLERANCE combined with excessive upright TACHYCARDIA, and usually without associated ORTHOSTATIC HYPOTENSION. All variants have in common an excessively reduced venous return to the heart (central HYPOVOLEMIA) while upright.

An autosomal disorder of the peripheral and autonomic nervous systems limited to individuals of Ashkenazic Jewish descent. Clinical manifestations are present at birth and include diminished lacrimation, defective thermoregulation, orthostatic hypotension (HYPOTENSION, ORTHOSTATIC), fixed pupils, excessive SWEATING, loss of pain and temperature sensation, and absent reflexes. Pathologic features include reduced numbers of small diameter peripheral nerve fibers and autonomic ganglion neurons. (From Adams et al., Principles of Neurology, 6th ed, p1348; Nat Genet 1993;4(2):160-4)

A degenerative disease of the AUTONOMIC NERVOUS SYSTEM that is characterized by idiopathic ORTHOSTATIC HYPOTENSION and a greatly reduced level of CATECHOLAMINES. No other neurological deficits are present.

Search BioPortfolio:

Relevant Topic

Nephrology - kidney function
Latest News Clinical Trials Research Drugs Reports Corporate
Nephrology is a specialty of medicine and pediatrics that concerns itself with the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation). Systemic conditions...