Materiały źródłowe

• #1 Orthostatic Hypotension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448192/

  Orthostatic hypotension is characterized by a sudden drop in blood pressure that occurs upon standing from a sitting or supine position. […] This sudden drop in blood pressure is usually caused by autonomic reflex failure, central or peripheral nervous system lesions, cardiac dysfunction, volume depletion, or adverse medication effects. […] Orthostatic hypotension occurs due to an inadequate physiological response to postural changes. […] Orthostatic hypotension occurs when there is an abnormal or delayed response to shifts in the body’s fluid balance upon standing, resulting in an exaggerated drop in SBP (20 mm Hg) or diastolic blood pressure (10 mm Hg). […] Several classification systems exist for the etiology of orthostatic hypotension, commonly distinguishing between neurogenic and non-neurogenic causes.

• #2 Orthostatic Hypotension: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p39.html

  Orthostatic hypotension is defined as a decrease in blood pressure of 20 mm Hg or more systolic or 10 mm Hg or more diastolic within three minutes of standing from the supine position or on assuming a head-up position of 60 degrees during tilt table testing. Symptoms are due to inadequate physiologic compensation and organ hypoperfusion and include headache, lightheadedness, shoulder and neck pain (coat hanger syndrome), visual disturbances, dyspnea, and chest pain. […] Orthostatic hypotension is classified as neurogenic or nonneurogenic, depending on etiology and heart rate response. […] Orthostatic hypotension occurs when there is inadequate intravascular volume or when sympathetic nervous system-mediated vasoconstriction is unable to compensate for gravitational pooling, leading to decreased organ perfusion and associated symptoms.

• #3 Orthostatic Hypotension – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/orthostatic-hypotension

  Orthostatic (postural) hypotension is an excessive fall in blood pressure (BP) when an upright position is assumed. The consensus definition is a drop of 20 mm Hg systolic, 10 mm Hg diastolic, or both (1). Symptoms of faintness, light-headedness, dizziness, confusion, or blurred vision occur within seconds to a few minutes of standing and resolve rapidly on lying down. Some patients experience falls, syncope, or even rarely generalized seizures. Exercise or a heavy meal may exacerbate symptoms. Most other associated symptoms and signs relate to the cause. […] Orthostatic hypotension is a manifestation of abnormal BP regulation due to various conditions, not a specific disorder. Evidence suggests that disorders of postural hemodynamic control increase risk of cardiovascular disease and all-cause mortality (2, 3).

• #4 Orthostatic hypotension (postural hypotension) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548

  Orthostatic hypotension also called postural hypotension is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting. […] Occasional orthostatic hypotension is usually caused by something obvious, such as dehydration or lengthy bed rest. The condition is easily treated. Chronic orthostatic hypotension is usually a sign of another health problem, so treatment depends on the cause. […] When standing from a sitting or lying position, gravity causes blood to collect in the legs and belly. Blood pressure drops because there’s less blood flowing back to the heart. […] Usually, special cells (baroreceptors) near the heart and neck arteries sense this lower blood pressure. The baroreceptors send signals to the brain. This tells the heart to beat faster and pump more blood, which evens out blood pressure. These cells also narrow the blood vessels and increase blood pressure.

• #5 Diagnosis and management of neurogenic orthostatic hypotension

  http://e-acn.org/journal/view.php?doi=10.14253/acn.2023.25.2.66

  Orthostatic hypotension is a sustained and pathological drop in blood pressure upon standing. […] Impaired baroreflex-mediated vasoconstriction and insufficient release of norepinephrine play key roles in the pathophysiology of neurogenic orthostatic hypotension. […] The major pathophysiological mechanism of N-OH is an inadequate release of norepinephrine after standing up. […] Fluid shift and blood pooling in the dependent areas after standing up produce a cascade of hemodynamic changes, including decreased venous return, a reduction in stroke volume by up to 40.0%, an overall decline in cardiac output, and eventually lower BP. […] The mechanoreceptors of the arterial baroreflex in the carotid sinus and the aortic arch sense changes in tension of the arterial walls secondary to changes in BP.

• #6 Orthostatic Hypotension – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/orthostatic-hypotension

  Normally, the gravitational stress of suddenly standing causes blood ( to 1 L) to pool in the veins of the legs and trunk. The subsequent transient decrease in venous return reduces cardiac output and thus BP. In response, baroreceptors in the aortic arch and carotid sinus activate autonomic reflexes to rapidly return BP to normal. The sympathetic nervous system increases heart rate and contractility and increases vasomotor tone of the capacitance vessels. Simultaneous parasympathetic (vagal) inhibition also increases heart rate. In most people, changes in BP and heart rate upon standing are minimal and transient, and symptoms do not occur. […] Homeostatic mechanisms may be inadequate to restore low BP if afferent, central, or efferent portions of the autonomic reflex arc are impaired by disorders or medications, if myocardial contractility or vascular responsiveness is depressed, if hypovolemia is present, or if hormonal responses are faulty (see table Causes of Orthostatic Hypotension).

• #7 Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8030387/

  Orthostatic hypotension (OH), that is blood pressure fall when standing from the supine to the erect position, is a common cardiovascular disorder, highly prevalent in elderly and frail individuals and in patients with multiple comorbidities. […] Orthostatic hypotension is considered a manifestation of dysfunction of the autonomic nervous system, caused or facilitated by several neurological or nonneurological diseases and conditions, while its clinical significance is increasingly recognized as a cause of impairment of quality of life and potentially of worse outcomes. […] Orthostatic hypotension occurs in patients with inadequate autonomic nervous system (ANS) adjustment and can be divided into three major categories: drug-induced, related to depletion of (total or effective) intravascular volume and neurogenic, while in many patients, such as the elderly, multiple causes may coexist.

• #8 Diagnosis and management of neurogenic orthostatic hypotension

  http://e-acn.org/journal/view.php?doi=10.14253/acn.2023.25.2.66

  The activated adrenergic fibers increase release of norepinephrine (NE), a key neurotransmitter for sympathetic vasoconstriction, at the neurovascular junction. […] In healthy people, plasma NE levels are doubled after standing from supine levels. However, NE increase is blunted in patients with N-OH.

• #9

  https://link.springer.com/article/10.1007/s00415-012-6736-7

  The prevalence of OH increases with age and is commonly associated with neurodegenerative diseases including Parkinsons disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA) and pure autonomic failure (PAF). […] Hallmark symptoms upon postural challenge include dizziness, visual disturbances, presyncope and syncope. […] In contrast to the afferent or central lesion of BF, there is failure of noradrenaline release from sympathetic vasomotor neurons in NOH. […] Loss of homeostatic mechanisms to control blood pressure fluctuations may contribute to the supine hypertension (systolic pressure 180 mmHg and/or diastolic pressure 110 mmHg) commonly encountered in the spectrum of NOH. […] Neurogenic orthostatic hypotension can arise from primary neurodegenerative disorders or can be secondary to systemic conditions that influence peripheral nerve function.

• #10 Neurogenic Orthostatic Hypotension: Pathophysiology and Diagnosis

  https://www.ajmc.com/view/ace0034_oct15_noh_low

  Although orthostatic hypotension in elderly patients is common, neurogenic orthostatic hypotension (NOH) is a condition with substantial morbidity and a variable prognosis. […] In neurogenic orthostatic hypotension (NOH), impaired vasoconstriction is caused by inadequate release of norepinephrine from sympathetic vasomotor neurons. […] NOH occurs primarily in autonomic degenerative disorders that are characterized by abnormal accumulation of alpha-synuclein. […] NOH can also be caused by peripheral neuropathies, such as diabetic neuropathy, amyloidosis, and Guillain-Barr syndrome; it also occurs with spinal cord injury. […] Patients with NOH tend to have more severe symptoms than patients with OH due to other causes. […] In NOH, a characteristic form of pain affects the back of the head and muscles in the neck in a coat-hanger distribution and may be due to ischemia of large neck muscles.

• #11 Progressive orthostatic hypotension in the elderly

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-5/Progressive-orthostatic-hypotension-in-the-elderly-Title-Progressive-orthosta

  Progressive orthostatic hypotension is characterised by a slow progressive decrease in systolic blood pressure upon the assumption of a standing position. […] Progressive orthostatic hypotension is commonly seen in the elderly because of age-related impairment in baroreflex mediated vasoconstriction and chronotropic responses of the heart, as well as to the deterioration of the diastolic filling of the heart. […] In patients with impaired compensatory reflexes the increased downward pooling of the venous blood and the consequent reduction in stroke volume and cardiac output exaggerates the orthostatic fall of blood pressure. […] Clinical features of progressive orthostatic hypotension may mimic those of vasovagal syncope suggesting that the pathophysiology of both disorders might be similar. […] To conclude, lower limb compression bandaging is effective in avoiding orthostatic systolic blood fall and reducing symptoms in elderly patients affected by progressive orthostatic hypotension.

• #12 Syndrome of Supine Hypertension with Orthostatic Hypotension. A Nightmare for Physicians

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2016/march/830-syndrome-of-supine-hypertension

  Supine hypertensionorthostatic hypotension (SH/OH) is a form of autonomic dysfunction characterized by hypertension when patients are supine and a clinically significant drop in blood pressure when they assume an upright posture. […] Pathophysiology of orthostatic hypotension. OH is defined as a reduction in systolic blood pressure by at least 20 mmHg or reduction in diastolic blood pressure by at least 10 mmHg within 3 min of assuming an upright posture. […] Pathophysiology of SH/OH. SH/OH develops in many patients with OH and autonomic failure, which describes a condition where sympathetic outflow is inhibited because postganglionic neurons are deficient in releasing norepinephrine, especially when upright. […] Long-term hypertension leads to desensitization of the baroreceptor reflex, which might also contribute to the pathogenesis of SH/OH.

• #13 An Overview of Orthostatic Hypotension

  https://www.uspharmacist.com/article/an-overview-of-orthostatic-hypotension

  Orthostatic hypotension is defined by the Consensus Committee of the American Autonomic Society and the American Academy of Neurology as a reduction of systolic blood pressure of at least 20 mmHg or a reduction of diastolic blood pressure of at least 10 mmHg within three minutes of standing. […] The Consensus Committee describes orthostatic hypotension as a physical sign, rather than a disease, that may be symptomatic or asymptomatic. […] Several studies have reported that orthostatic hypotension is a potential risk factor for vascular-related death, myocardial infarction, coronary heart disease, transient ischemic attack, falls, and fractures. […] Orthostatic hypotension has also been associated with increased mortality. […] In healthy individuals, gravitational venous pooling in the legs and abdomen begins immediately when they change from supine to standing position.

• #14 Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology | Spinal Cord

  https://www.nature.com/articles/3101855

  The higher the level of injury, the greater the level of impairment of efferent sympathetic nerves. […] This disruption of spinal sympathetic pathways would be likely to affect the vascular resistance responses to orthostasis, particularly in the dependent regions. […] It has been demonstrated previously that these vascular resistance responses play a crucial role in cardiovascular control during orthostatic stress, and any impairment in vascular resistance responses following SCI will predispose to orthostatic intolerance. […] The established test to assess the severity of orthostatic hypotension is to perform tilt testing. […] SCI patients are lacking this skeletal muscle pumping effect, and this would predispose to circulatory hypokinesis by reducing venous return in the upright position and thus lowering stroke volume, cardiac output and blood pressure.

• #15 Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology | Spinal Cord

  https://www.nature.com/articles/3101855

  Cardiovascular deconditioning refers to a spectrum of physiological disorders that develop following prolonged bed rest, or exposure to microgravity (such as that which occurs during space flight). […] In patients with chronic SCI, there is evidence of impaired water and sodium retention in the seated position, and limited salt and water intake. […] The combination of increased ADH secretion, low sodium intake, high sodium excretion and the resulting hyponatremia are likely to predispose towards small plasma volumes in SCI patients, and this, in turn, would exacerbate episodes of orthostatic hypotension in these individuals. […] The mechanisms underlying this tolerance to hypotension are unclear, but since the ultimate cause of symptoms in these individuals is known to be due to cerebral hypoperfusion, it is likely that there is a shift in cerebral autoregulation in these individuals, whereby cerebral blood flow is maintained despite low perfusion pressures.

• #16 Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8030387/

  Neurogenic OH is mainly attributed to diminished release of norepinephrine from sympathetic nerves and is generally characterized by lower heart rate increase when standing in the erect position compared with patients with nonneurogenic causes of OH. […] Aging predisposes to OH and orthostatic BP fall in the elderly merits special consideration. […] Several physiological changes that may affect proper response to orthostasis can be triggered by aging. […] These physiological alterations can result in reduced intravascular volume, reduced stroke volume, and blunted chronotropic and vasoconstrictive response after standing, thus promoting OH. […] Furthermore, hypertension, regardless of treatment status, is closely linked to OH, since hypertensives as well often present ANS dysfunction, cardiac hypertrophy, and increased arterial stiffness, conditions that together or separately blunt the response of the cardiovascular system to orthostatism.

• #17 Orthostatic hypotension: Causes, symptoms, and prevention

  https://www.medicalnewstoday.com/articles/318158

  Orthostatic, or postural, hypotension is defined as a sudden drop in blood pressure resulting from a change in posture, such as when a person stands up quickly. […] If the body is unable to do this sufficiently, blood pressure falls, which may lead to symptoms, such as dizziness, blurred visions, or fainting. […] People who have orthostatic hypotension often experience a drop in blood pressure of about 20/10 mmHg within 3 minutes of standing. […] Orthostatic hypotension is common among people who are 65 or older because the body’s ability to react to drops in blood pressure can slow down as a person ages. […] Loss of fluid within the blood vessels is the most common cause of symptoms linked to orthostatic hypotension. […] Some medications, such as beta-blockers and antidepressants, can also trigger symptoms linked to orthostatic hypotension.

• #18 Orthostatic Hypotension: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p39.html

  Orthostatic hypotension is further classified as neurogenic or nonneurogenic. Neurogenic orthostatic hypotension is caused by an intrinsic failure of the autonomic nervous system to create a normal physiologic response (baroreflex dysfunction). […] Measuring heart rate with each position change can help detect baroreflex dysfunction. The compensatory rise in heart rate is maintained in nonneurogenic orthostatic hypotension, whereas the heart rate response is markedly reduced or absent in neurogenic orthostatic hypotension.

• #19 Orthostatic Hypotension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448192/

  Neurogenic orthostatic hypotension results from autonomic instability due to neuropathic or neurodegenerative disease, or aging conditions. […] Non-neurogenic orthostatic hypotension is typically associated with volume depletion or cardiac dysfunction. […] Orthostatic hypotension is linked to other causes of morbidity, such as cardiovascular and neurodegenerative diseases. […] The management of orthostatic hypotension is determined by its underlying cause. […] Pharmacological treatment is considered when non-pharmacological interventions fail to alleviate symptoms.

• #20 Orthostatic Hypotension : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/orthostatic-hypotension/

  Orthostatic Hypotension is the second most common etiology of syncope, occurring in approximately 15% of syncope presentations. Often unrecognized or overlooked factor associated with increased cardiovascular morbidity and all-cause mortality. […] Orthostatic hypotension: decrease in systolic blood pressure of 20 mmHg or decrease in diastolic blood pressure of 10 mmHg within 3 minutes of standing compared with blood pressure from the sitting or supine position. […] Delayed orthostatic hypotension: gradual impairment of adaptive mechanisms during orthostasis, resulting in slow decrease in sBP ≥20 mmHg or diastolic ≥10 mmHg, between 3 and 45 minutes. […] Neurogenic: lower heart rate increase when standing upright (usually <10-15 bpm) compared with nonneurogenic causes (usually >15 bpm). […] Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. […] Mechanisms, causes, and evaluation of orthostatic hypotension.

• #21 Orthostatic hypotension – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/972

  Treatment consists of addressing any underlying pathology, when possible, followed by discontinuing or reducing the dose of aggravating drugs, and introducing nonpharmacologic countermeasures (e.g., liberalization of salt intake, use of abdominal binders or compression stockings). […] OH is defined as a fall in systolic blood pressure of at least 20 mmHg (at least 30 mmHg in patients with hypertension) and/or a fall in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing. […] When OH has an underlying neurogenic cause (e.g., peripheral neuropathy or synucleinopathies) it is associated with a blunted increase in heart rate, typically less than 15 bpm. […] OH becomes clinically significant if it is accompanied by symptoms of cerebral hypoperfusion, which can lead to syncope and falls. […] OH is associated with increased risk of dementia and cardiovascular disease, and is an independent risk factor for all-cause mortality. […] This topic concentrates on OH caused by autonomic problems.

• #22 Orthostatic Hypotension

  https://mobile.fpnotebook.com/CV/Exam/OrthstcHyptnsn.htm

  Orthostatic Hypotension causes include inadequate autonomic response or insufficient intravascular volume or circulation […] Compensatory Heart Rate response to standing is typically ABSENT in neurogenic Orthostatic Hypotension […] Compensatory Heart Rate response to standing is typically PRESENT in non-neurogenic Orthostatic Hypotension

• #23 Orthostatic hypotension – Wikipedia

  https://en.wikipedia.org/wiki/Orthostatic_hypotension

  Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person’s blood pressure drops when they are standing up (orthostasis) or sitting down. The drop in blood pressure may be sudden (vasovagal orthostatic hypotension), within 3 minutes (classic orthostatic hypotension) or gradual (delayed orthostatic hypotension). It is defined as a fall in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg after 3 minutes of standing. It occurs predominantly by delayed (or absent) constriction of the lower body blood vessels, which is normally required to maintain adequate blood pressure when changing the position to standing. As a result, blood pools in the blood vessels of the legs for a longer period, and less is returned to the heart, thereby leading to a reduced cardiac output and inadequate blood flow to the brain.

• #24 Postural hypotension – GPnotebook

  https://gpnotebook.com/pages/cardiovascular-medicine/postural-hypotension

  Orthostatic hypotension (OH) or postural hypotension occurs when mechanisms for the regulation of orthostatic BP control fail. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. […] Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fail such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. […] Profiling with continuous blood pressure measurements have uncovered four major subtypes: initial orthostatic hypotension, delayed blood pressure recovery, classic orthostatic hypotension, delayed orthostatic hypotension. […] Neurogenic orthostatic hypotension might be the earliest clinical manifestation of Parkinson’s disease or related synucleinopathies, and often coincides with supine hypertension. […] Treatment of OH – management and prognosis vary according to the underlying cause, with the main distinction being whether orthostatic hypotension is neurogenic or non-neurogenic.

• #25 Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8030387/

  Orthostatic hypotension is believed to occur more frequently in the morning after awakening and after large meals (postprandial OH). […] The pathophysiology of autonomic failure resulting in orthostatic hypotension involves the afferent pathway transferring information from the baroreceptors to the central nervous system, and the efferent pathway regulating the compensatory responses of the cardiovascular system. […] In summary, OH is a frequent cardiovascular disorder with ANS dysfunction being in the center of its pathogenesis.

• #26 Orthostatic hypotension (postural hypotension) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548

  Orthostatic hypotension occurs when something interrupts the body’s process of dealing with the low blood pressure. Many conditions can cause orthostatic hypotension, including: […] Dehydration decreases blood volume. Mild dehydration can cause symptoms of orthostatic hypotension, such as weakness, dizziness and fatigue. […] Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure. […] Thyroid conditions, adrenal insufficiency (Addison’s disease) and low blood sugar (hypoglycemia) can cause orthostatic hypotension. […] Some nervous system disorders, such as Parkinson’s disease, multiple system atrophy, Lewy body dementia, pure autonomic failure and amyloidosis, can disrupt the body’s ability to control blood pressure. […] Some people have low blood pressure after eating meals (postprandial hypotension). This condition is more common in older adults.

• #27 Orthostatic Hypotension and other Autonomic Failure Syndromes: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1154266-overview

  The principal forms of autonomic failure are pure autonomic failure (PAF), autoimmune autonomic neuropathy (AAN), multiple system atrophy (MSA), and postural orthostatic tachycardia syndrome (POTS). […] Patients who are initially identified as having PAF may have underlying pathology consistent with MSA or Parkinson’s disease, or they may be found to have AAN after extensive testing. […] The cause of AAN is presumed to be autoimmune. […] In MSA with autonomic involvement, changes in the intermediolateral cell column also may be seen; in addition, widespread abnormalities are apparent in the brain. […] A norepinephrine transporter deficiency has been identified in 1 family. […] Some patients have restricted autonomic neuropathy. […] Vitamin B12 is involved in catecholamine metabolism, and Oner and colleagues have suggested that vitamin B12 deficiency in adolescents may cause sympathetic baroreceptor dysfunction.

• #28 Orthostatic Hypotension Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/orthostatic_hypotension/article.htm

  Orthostatic hypotension has many potential causes, some affecting only one part of the system that supplies blood to the brain, and others affecting two or three. Loss of fluid within the blood vessels is the most common reason to develop the symptoms of orthostatic hypotension. […] Medications that affect the autonomic nervous system may also cause orthostatic hypotension. […] A vasovagal episode is a condition that may occur when a stimulus causes excess activation of the parasympathetic system, slowing the heart rate and dilating blood vessels. […] Patients with diabetes may develop peripheral neuropathy that can affect nerves of the autonomic nervous system, and as a result, may develop orthostatic hypotension. […] Disorders of the nervous system may also cause orthostatic hypotension. Examples include Parkinsonism, amyloidosis, and Shy-Drager Syndrome (or multiple system atrophy).

• #29

  https://link.springer.com/article/10.1007/s00415-012-6736-7

  The prevalence of NOH in PD ranges from 16 to 58 %. […] MSA-associated NOH symptoms are present in more than two-thirds of all patients. […] A structured approach is important in the management of patients with NOH. […] Non-pharmacological measures should be considered first in NOH. […] Two different mechanistic targets are approached in the pharmacological treatment of NOH, namely volume expansion and vasoconstriction. […] Bearing in mind that impaired norepinephrine release from sympathetic neurons is the central mechanism in NOH pathophysiology, sympathomimetic drugs yielding to vasoconstriction may be helpful in the treatment of NOH. […] Neurogenic orthostatic hypotension can seriously impair patients quality of life and is associated with increased morbidity, especially in the elderly.

• #30 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2015.11.3.220

  Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fails. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. OH is common in the elderly and is associated with an increase in mortality rate. […] The „prevalence” of OH increases with age and occurs in 10-30% of elderly persons. […] BP control becomes progressively more impaired with aging, due to a multitude of reasons including impaired baroreflex sensitivity, volume status, and venomotor tone. […] The presence of OH is associated with increased mortality and morbidity. […] The normal human subject maintains the same BP supine and standing. This maintenance of postural normotension depends on a normal plasma volume, intact baroreflexes, and reasonable venomotor tone.

• #31 An Overview of Orthostatic Hypotension

  https://www.uspharmacist.com/article/an-overview-of-orthostatic-hypotension

  There are a number of associated comorbidities of orthostatic hypotension. […] Orthostatic hypotension was found to be statistically predictive of ischemic stroke, even after adjustment for numerous other stroke risk factors. […] In another study, orthostatic hypotension was significantly associated with isolated systolic hypertension. […] There are also a number of consequences of orthostatic hypotension that can lead to decreased quality of life, such as headaches, blurred vision, syncope, falls, fractures, and dyspnea. […] The predominant cause of the signs and symptoms of orthostatic hypotension is the inability of the body to compensate the normal gravitational pooling of the blood in the lower extremities and abdomen. […] Therefore, nonpharmacologic approaches should focus on decreasing venous pooling, avoiding volume depletion, and increasing plasma volume.

• #32 An Overview of Orthostatic Hypotension

  https://www.uspharmacist.com/article/an-overview-of-orthostatic-hypotension

  One feature that distinguishes a nonneurogenic cause from a neurogenic cause is that the postural drop in blood pressure that is associated with nonneurogenic etiologies is accompanied by a compensatory increase in heart rate. […] Nonneurogenic causes of orthostatic hypotension include cardiac pump failure, reduced intravascular volume, venous pooling, or causative medications. […] It is estimated that about 50% of orthostatic hypotension cases involve causative medications. […] Antihypertensives that impair autonomic reflex mechanisms are frequent causes of orthostatic hypotension. […] Therefore, the use of potentially causative medications for orthostatic hypotension should be carefully evaluated in older patients, particularly those who have concurrent illnesses that can cause orthostatic hypotension, such as cardiac impairment, low intravascular volume, or vasodilation.

• #33 Drug-induced orthostatic hypotension: A systematic review and meta-analysis of randomised controlled trials | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003821

  The physiological transition from a supine to upright position involves redistribution of intravascular volume causing a transient reduction in venous return, a decrease in stroke volume, cardiac output, and BP. In a normal response, activation of BP-regulating reflexes leads to stimulation of the sympathetic system, increasing heart rate, venous return, cardiac contractility, and vascular tone, eventually restoring BP within seconds. Drug-induced OH can impair mechanisms in this process. […] We have conducted a systematic review and meta-analysis of 69 placebo-controlled RCTs to investigate the extent to which specific medications are associated with OH in adults. Compared with placebo, beta-blockers and TCAs were associated with a 6- to 7-fold increased odds of OH. […] The drugs associated with highest odds of OH in our study (alpha-blockers, alpha-agonists, antipsychotics, beta-blockers, and TCAs) all share a common key mechanism of sympathetic inhibition causing cardioinhibitory effects.

• #34 Hypotension: Postprandial and Orthostatic

  https://www.uspharmacist.com/article/hypotension-postprandial-and-orthostatic

  A recent study conducted in Ireland concluded that postprandial hypotension (PPH) and orthostatic hypotension (OH) are among the most common cardiac disorders that cause falls and syncope. […] Hypotension can be caused by a change in either the CO or the PVR. This article discusses two types of hypotensionpostprandial and orthostatic. It is important to note that both of these are additive rather than synergistic mechanisms. […] The joint consensus of the American Autonomic Society and the American Academy of Neurology defines OH as a reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing. […] OH can be caused by both neurogenic and nonneurogenic factors that fall into one of four categories: drugs, autonomic disorders, hypovolemia, and miscellaneous disorders. […] The effective management of OH is essential since it is a predictor of vascular deaths, particularly in the elderly and in patients with diabetes.

• #35 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2015.11.3.220

  A subject with reduced plasma volume (hypovolemia) can develop OH. Similarly, OH can occur in some subjects (predisposed to OH) because of excessive venous pooling. […] If the baroreflexes fail, as in adrenergic autonomic failure, there are several consequences. […] The goal of treatment is to avoid the severe effects of OH and empower the patient to boost defenses against OH during periods of increased orthostatic stress.

• #36 Prognostic value of postural hypotension in hospitalized patients with heart failure | Scientific Reports

  https://www.nature.com/articles/s41598-022-06760-0

  Although postural hypotension (PH) is reportedly associated with mortality in the general population, the prognostic value for heart failure is unclear. […] PH is a multifactorial syndrome that occurs when the blood pressure is notably decreased after moving to the upright posture from the supine or sitting position. […] Moreover, it has been shown that PH is associated with the incidence of heart failure and all-cause mortality in the general population. […] Previous studies have demonstrated that heart failure is an etiological factor for PH, and that PH is a cause of heart failure. […] However, very few studies with limited sample sizes have evaluated the clinical implications of PH in patients with heart failure, and of note, no study has addressed the prognostic value. […] In conclusion, PH was associated with reduced risk of heart failure readmission but not with 1-year mortality in older patients with heart failure.

• #37 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Orthostatic-Hypotension-Symptoms-and-Causes.aspx

  Thyroid-related problems, adrenal insufficiency, and low or high blood glucose level can significantly disrupt blood pressure regulation by damaging neuronal transmission. […] Some underlying nervous system disorders, such as Parkinson’s disease, multiple system atrophy, Lewy body dementia, and amyloidosis, increase the risk of developing orthostatic hypotension. […] The risk of orthostatic hypotension increases with age and fragility and is associated with prolonged standing and other chronic medical conditions. […] Medicines used for the treatment of high blood pressure (beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, nitrates, and angiotensin II blockers) and anxiety, depression, erectile dysfunction, and those used to increase urination (such as diuretics) may also cause orthostatic hypotension.

• #38 Neurogenic Orthostatic Hypotension: Pathophysiology and Diagnosis

  https://www.ajmc.com/view/ace0034_oct15_noh_low

  Patients with NOH become symptomatic when standing SBP falls below the range of cerebrovascular autoregulation. […] Approximately half of patients with NOH also have supine hypertension (SH). […] The initial diagnosis of NOH is based on blood pressure and heart rate measurements taken after the patient has been supine for at least 5 minutes, and then after 1 and 3 minutes of active standing. […] The diagnosis of NOH should consider 2 variants: initial and delayed OH.

• #39 Orthostatic hypotension: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/orthostatic-hypotension/

  Orthostatic hypotension is a drop in blood pressure that occurs when moving from a laying down (supine) position to a standing (upright) position. The word „orthostasis” means to stand up, so the condition is defined as low blood pressure (hypotension) that occurs upon standing. […] The body has difficulty achieving stable blood pressure in people with orthostatic hypotension, resulting in a prolonged drop in blood pressure that occurs within minutes after moving from laying down to standing. […] When signs and symptoms of orthostatic hypotension do occur, they are usually the result of a reduction in blood flow (hypoperfusion) to tissues, particularly the brain. […] In people with orthostatic hypotension, hypoperfusion to other organs contributes to an increased risk of life-threatening health problems, including heart attack or heart failure, a heart rhythm abnormality called atrial fibrillation, stroke, or chronic kidney failure.

• #40 Orthostatic hypotension – Wikipedia

  https://en.wikipedia.org/wiki/Orthostatic_hypotension

  Chronic orthostatic hypotension is associated with cerebral hypoperfusion that may accelerate the pathophysiology of dementia. The numerous possible causes for orthostatic hypotension include certain medications (e.g. alpha blockers), autonomic neuropathy, decreased blood volume, multiple system atrophy, and age-related blood-vessel stiffness. […] Orthostatic hypotension happens when gravity causes blood to pool in the lower extremities, which in turn compromises venous return, resulting in decreased cardiac output and subsequent lowering of arterial pressure. For example, changing from a lying position to standing loses about 700 ml of blood from the thorax, with a decrease in systolic and diastolic blood pressures. The overall effect is insufficient blood perfusion in the upper part of the body.

• #41 Orthostatic Hypotension (Postural Hypotension)

  https://my.clevelandclinic.org/health/diseases/9385-low-blood-pressure-orthostatic-hypotension

  Orthostatic hypotension treatments vary by whats causing it. […] Rarely, people with orthostatic hypotension need medications to increase blood volume and pressure. […] Orthostatic hypotension symptoms can be unsettling. They may even be dangerous if you lose your balance, fall or pass out. Symptoms often improve when you change how you move into a standing position.

• #42 Orthostatic hypotension: Causes, symptoms, and prevention

  https://www.medicalnewstoday.com/articles/318158

  A common complication of orthostatic hypotension is falling over as a result of losing consciousness, which could cause serious injuries. […] The sudden drops in blood pressure caused by orthostatic hypotension are a risk factor for strokes because of the reduced blood supply to the brain. […] There are several ways of managing or preventing orthostatic hypotension, most of which do not involve the use of medication. […] Severe cases of orthostatic hypotension can be treated with drugs to raise blood pressure.

• #43 Orthostatic hypotension (postural hypotension) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/orthostatic-hypotension-postural-hypotension

  Thyroid conditions, adrenal insufficiency (Addison’s disease) and low blood sugar (hypoglycemia) can cause orthostatic hypotension. So can diabetes, which can damage the nerves that help send signals that control blood pressure. […] Some nervous system disorders, such as Parkinson’s disease, multiple system atrophy, Lewy body dementia, pure autonomic failure and amyloidosis, can disrupt the body’s ability to control blood pressure. […] Persistent orthostatic hypotension can cause serious complications, especially in older adults. […] Orthostatic hypotension can be a risk factor for cardiovascular diseases and complications, such as chest pain, heart failure or heart rhythm problems. […] Treatment for orthostatic hypotension is directed at the cause rather than the low blood pressure itself. […] If orthostatic hypotension doesn’t improve with lifestyle changes, medications may be needed to increase blood pressure or blood volume. The type of medication depends on the type of orthostatic hypotension.

• #44 Syndrome of Supine Hypertension with Orthostatic Hypotension. A Nightmare for Physicians

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2016/march/830-syndrome-of-supine-hypertension

  Another contributing factor to SH/OH could be residual sympathetic tone acting on postsynaptic adrenergic receptors that have become hypersensitive. […] Patients with OH because of autonomic failure (primary or secondary) may at times develop supine hypertension, which could be a result of the medications used for the treatment of OH. […] The mechanism of SH and OH could very well share a common mechanism related to the baroreflex failure.

• #45 Orthostatic Hypotension: Mechanisms, Causes, Management

  https://www.kci.go.kr/kciportal/landing/article.kci?arti_id=ART002006802

  Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fails. Such regulation depends on the barorefexes, normal blood volume, and defenses against excessive venous pooling. OH is common in the elderly and is associated with an increase in mortality rate. […] Aging coupled with diseases such as diabetes and Parkinsons disease results in a prevalence of 1030% in the elderly. Tese conditions cause barorefex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP. […] The treatment of OH is imperfect since it is impossible to normalize standing BP without generating excessive supine hypertension. Te practical goal is to improve standing BP so as to minimize symptoms and to improve standing time in order to be able to undertake orthostatic activities of daily living, without excessive supine hypertension. It is possible to achieve these goals with a combination of fudrocortisone, a pressor agent (midodrine or droxidopa), supplemented with procedures to improve orthostatic defenses during periods of increased orthostatic stress. Such procedures include water bolus treatment and physical countermaneuvers.

• #46 Orthostatic Hypotension in SCI | PM&R KnowledgeNow

  https://now.aapmr.org/orthostatic-hypotension-in-sci/

  Orthostatic hypotension (OH) is defined as a reduction in systolic blood pressure (BP) of at least 20 mm Hg or a reduction in diastolic BP of at least 10 mm Hg within 3 minutes of standing or head-up tilting to 60 degrees. […] The major underlying abnormality in SCI-related OH is due to sympathetic interruption. The lack of sympathetically mediated reflex vasoconstriction, especially in large vascular beds, such as those supplying the splanchnic region and skeletal muscle result in an inability to compensate for changes in posture. […] In the acute stage, OH is a result of losing vasomotor tone coupled with venous pooling in the peripheral and splanchnic vasculature. In the chronic stage, OH is due to the reduction/loss of sympathetic activity below the level of the injury. […] Several drugs have been used to treat OH, though effectiveness varies. The drugs for which there has been the most experience in use for SCI-related OH include fludrocortisone and midodrine. Only midodrine and droxidopa are currently approved by the Food and Drug Administration (FDA) for the treatment of neurogenic OH. […] The goal of treatment is to alleviate the disability caused by symptoms, rather than to achieve an optimal target blood pressure reading.

• #47 Key points from the evidence | Orthostatic hypotension due to autonomic dysfunction: midodrine | Advice | NICE

  https://www.nice.org.uk/advice/esnm61/chapter/key-points-from-the-evidence

  The European Federation of Neurological Societies advises that, rather than achieving a target blood pressure, goals of treatment for orthostatic hypotension are improving functional capacity and quality of life, and preventing injury. […] Midodrine is commonly associated with adverse effects, which can sometimes be serious (for example, supine hypertension), and it seems sensible to consider a trial of the drug only when other options have been tried and the patient’s quality of life remains adversely affected by the condition.

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