Orthostatic Hypotension (Postural Hypotension)

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.

Also Known As:

Networked: 2010 relevant articles (115 outcomes, 172 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hypertension (High Blood Pressure)
2.	Dizziness (Lightheadedness)
3.	Anemia
4.	Nausea
5.	Hypotension (Low Blood Pressure)

Experts

1.	Goldstein, David S: 31 articles (11/2015 - 11/2002)
2.	Holmes, Courtney: 16 articles (11/2015 - 06/2003)
3.	Low, Phillip A: 15 articles (07/2015 - 10/2002)
4.	Sharabi, Yehonatan: 13 articles (11/2015 - 08/2003)
5.	Biaggioni, Italo: 13 articles (07/2015 - 07/2003)
6.	Fedorowski, Artur: 12 articles (08/2015 - 05/2009)
7.	Kenny, Rose Anne: 11 articles (12/2015 - 09/2003)
8.	Robertson, David: 11 articles (07/2015 - 11/2002)
9.	Melander, Olle: 10 articles (08/2015 - 05/2009)
10.	Mathias, Christopher J: 9 articles (01/2015 - 11/2004)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Orthostatic Hypotension:

1.	Midodrine (Midon)FDA LinkGeneric 05/01/1994 - "The efficacy of Midodrine in successfully treating orthostatic hypotension secondary to autonomic failure has been shown in clinical trials. " 06/01/1988 - "Autonomic cardiovascular reflexes were significantly more impaired in patients of group II than in patients of group I. We conclude that midodrine is effective in the treatment of orthostatic hypotension only in those patients with significant preservation of autonomic reflexes. " 07/01/1993 - "We conclude that midodrine is an effective and well-tolerated treatment for moderate-to-severe orthostatic hypotension associated with autonomic failure." 06/01/1993 - "Therefore, midodrine is an effective and safe agent for the treatment of neurogenic orthostatic hypotension." 08/06/1997 - "Efficacy of midodrine for neurogenic orthostatic hypotension."
2.	FludrocortisoneIBA 07/01/1990 - "The orthostatic hypotension of the patient as effectively treated with fludrocortisone. " 02/01/2000 - "The aim of the present study was to examine whether the improvement in orthostatic blood pressure during combined treatment with low-dose fludrocortisone and nocturnal head-up tilt in patients with neurogenic orthostatic hypotension can be attributed to expansion of plasma volume or to increased total peripheral resistance. " 08/01/2005 - "Since only fludrocortisone negatively altered gene expression, we assessed fludrocortisone's efficacy in treating postural hypotension, and its effect on survival and secondary long-term FD problems. " 02/01/2000 - "The improvement in upright blood pressure in orthostatic hypotension during treatment with fludrocortisone and nocturnal head-up sleeping is the result of a reduction in the orthostatic decrease in cardiac output. " 08/01/2011 - "Fludrocortisone is a reasonable first choice for symptomatic orthostatic hypotension. "
3.	DroxidopaIBA 01/01/2015 - "Additional clinical trials are needed to confirm that droxidopa is beneficial in symptomatic neurogenic orthostatic hypotension, as suggested by the positive secondary outcomes of this trial. " 02/01/2015 - "Oral droxidopa was effective in the shorter-term treatment of patients with symptomatic neurogenic orthostatic hypotension, with improvements seen in symptoms, the impact of symptoms on daily activities and standing systolic blood pressure. " 09/15/2015 - "In addition, two randomized, placebo-controlled, double-blind trials have studied the efficacy of droxidopa in the symptomatic treatment of neurogenic orthostatic hypotension, including patients with MSA, with positive results in one trial. " 03/01/1999 - "The enhanced responses of these vasoactive mediators by L-threo-DOPS during head-up tilt may contribute to the improvement in orthostatic hypotension in patients with MSA." 01/01/2015 - "Randomized withdrawal study of patients with symptomatic neurogenic orthostatic hypotension responsive to droxidopa."
4.	Norepinephrine (Noradrenaline)FDA LinkGeneric 08/01/2015 - "A norepinephrine infusion was effective for treating orthostatic hypotension." 08/01/2015 - "As an additional examination, the efficacy of norepinephrine in treating orthostatic hypotension was also assessed. " 03/01/2011 - "Reduction in nAChR antibody titer resulted in a decrease in orthostatic hypotension, an increased concentration of upright plasma norepinephrine, improvement in some sweat function, and improvement in symptoms. " 01/01/2001 - "This study was designed to establish a patient-controlled, ambulatory norepinephrine treatment of refractory orthostatic hypotension due to primary autonomic failure. " 08/01/2015 - "Norepinephrine prevented the reduction of total peripheral resistance and development of orthostatic hypotension. "
5.	ErythropoietinFDA Link 12/01/1997 - "The objective of this study was to determine the alteration of autonomic control during erythropoietin therapy in a patient with severe autonomic failure and severe symptomatic orthostatic hypotension, evaluated by spectral analysis of heart rate variability. " 01/01/2003 - "Successful treatment of severe orthostatic hypotension with erythropoietin." 10/01/2002 - "Additional options for treatment of orthostatic hypotension include erythropoietin and, surprisingly, water. " 06/01/2001 - "Erythropoietin treatment of postural hypotension in anemic type 1 diabetic patients with autonomic neuropathy: a case study of four patients." 12/01/1996 - "Erythropoietin treatment for postural hypotension from autonomic dysfunction."
6.	hydroxide ionIBA 10/01/1999 - "This is reflected from the findings that the mean magnitude of OH (orthostatic hypotension) and the rate of BP decrease induced by the HD-HU maneuver is significantly greater in roll rotation than pitch rotation. " 07/01/2013 - "To assess the efficacy of a leg exercise performed in supine position to prevent orthostatic hypotension (OH) in older adults. " 02/01/2016 - "The aim of this study is to evaluate the influence of SBT on BP and whether SBT induces orthostatic hypotension (OH) or changes in quality of life (QoL) in CHF patients. " 06/01/2015 - "Orthostatic hypotension (OH) is a common problem in the elderly age group, and some studies have reported an association between OH and increased mortality. " 01/01/2014 - "aims of the current study were 1) to evaluate global cognitive function in patients with autonomic failure (AF) of peripheral origin and 2) to investigate the effect of a documented fall in blood pressure (BP) fulfilling the criteria for orthostatic hypotension (OH) on cognitive performances. "
7.	Levodopa (L Dopa)FDA LinkGeneric 01/01/1993 - "This study was undertaken to clarify the mechanism of orthostatic hypotension, one of the side effects frequently encountered after administration of levodopa (L-dopa). " 02/01/2013 - "The existence of RBD, but not subclinical RBD, was associated with orthostatic hypotension and levodopa dose equivalents (LDEs) in patients with PD. " 01/01/2011 - "The disease duration was 1-25 years, mean 6.5 years, L-dopa treatment duration was 1-20 years, mean 6.04 years, L-dopa dose was 300-2000 mg/24 h, mean 636 mg/24 h, UPDRS score was 8-103 pts, mean 36.38 pts. Orthostatic hypotension was found in approximately 16% of the patients. " 07/01/2007 - "In contrast, levodopa significantly lowered BP and HR at rest and enhanced orthostatic hypotension. " 04/01/2007 - "Orthostatic hypotension in PD is more frequent in women, patients taking a higher dose of levodopa, in higher age groups, and patients with longer duration of the disease, however, a statistically significant difference was seen in the female group and patients taking a higher dose of levodopa. "
8.	Yohimbine (Yocon)IBA 01/01/1980 - "Yohimbine appears to be the most effective treatment for orthostatic hypotension, either essential or induced by thymoanaleptic or neuroleptic therapy." 02/01/1987 - "Yohimbine may be useful in the treatment of orthostatic hypotension associated with autonomic failure. " 01/01/1997 - "Yohimbine has been proposed for the treatment of neurogenic orthostatic hypotension; however, no controlled trial has been performed in experimental models of orthostatic hypotension or in patients with autonomic failure. " 01/01/1993 - "Lack of yohimbine effect on ambulatory blood pressure recording: a double-blind cross-over trial in parkinsonians with orthostatic hypotension." 01/01/1997 - "These results show that, in the model of orthostatic hypotension obtained by SAD, yohimbine, at an alpha 2-adrenoceptor selective dose (0.05 mg/kg), delays the fall in blood pressure elicited by head-up tilting. "
9.	SodiumIBA 02/01/2002 - "We conclude that high sodium intake is an effective treatment for orthostatic hypotension in combination with vasoactive drugs." 02/01/2002 - "Efficacy of high sodium intake in a boy with instantaneous orthostatic hypotension." 09/01/1981 - "This study indicated that long-term converting enzyme inhibition and sodium depletion were safe and did not appreciably blunt the cardiovascular reflexes responsible for prevention of orthostatic hypotension." 08/01/2006 - "Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension." 04/01/2001 - "Orthostatic hypotension may complicate very-low-calorie protein diets because of sodium depletion and depressed sympathetic nervous system activity. "
10.	Octreotide (Sandostatin)FDA LinkGeneric 10/01/1995 - "4. After octreotide, although the rate of blood pressure recovery was similar post-exercise, the levels of blood pressure were higher than in the non-treatment phase and postural hypotension was improved before and after exercise. " 02/01/1992 - "Lack of efficacy of octreotide in the long term treatment of orthostatic hypotension." 01/01/1999 - "Octreotide for orthostatic hypotension." 01/01/1997 - "Effects of octreotide on experimental neurogenic orthostatic hypotension in anaesthetized dogs." 08/01/1996 - "These results suggest that 1) this experimental model of orthostatic hypotension in SAD dogs is reproductible and can be used to investigate the pharmacological effects of antihypotensive drugs, 2) cardiovascular and biochemical characteristics of the SAD model are similar to those observed in MSA and 3) octreotide, in these experimental conditions, is not able to correct the BP fall during head-up tilt test."

Therapies and Procedures

1.	Renal Dialysis (Hemodialysis) 04/01/2002 - "Orthostatic hypotension is one of the major factors interfering with everyday activities in hemodialysis patients, but there has been no effective agent for treating it. " 04/01/2002 - "These findings indicate that L-DOPS taken before hemodialysis prevents orthostatic hypotension in patients undergoing hemodialysis, and is also effective for the interdialytic symptoms related to orthostatic hypotension." 04/01/2002 - "In order to clarify the clinical effects of L-threo-3,4-dihydroxyphenylserine (L-DOPS) on orthostatic hypotension of hemodialysis patients, we conducted a randomized, double-blind comparative trial. " 01/01/2010 - "Orthostatic hypotension during a hemodialysis (HD) session affects not only the modality but daily quality of life for HD patients because many of them have combined dysfunction of both sympathetic and parasympathetic nervous systems. " 11/01/2006 - "Treatment of post-dialytic orthostatic hypotension with an inflatable abdominal band in hemodialysis patients."
2.	Deep Brain Stimulation 06/01/2006 - "Our aim was to assess whether orthostatic hypotension can be successfully treated with deep brain stimulation of the periventricular/periaqueductal gray areas in humans. " 10/01/2015 - "Deep Brain Stimulation Ameliorates Postural Hypotension in Parkinson's Disease."
3.	Drug Therapy (Chemotherapy) 09/01/1994 - "The objectives of this study were to determine the prevalence of, and factors associated with, postural hypotension (PH) in elderly treated hypertensive subjects, to examine the 24h BP profile in those subjects with and without PH and to determine the effects of antihypertensive treatment withdrawal on the prevalence and symptoms of PH. Eighty-six subjects (mean age +/- standard deviation 76 +/- 6 years) on antihypertensive drug therapy for > 6 months had three clinic BP measurements taken in supine and standing positions followed by 24h ambulatory BP monitoring. " 11/15/2011 - "Orthostatic hypotension, however, is increasingly recognised in PD, and especially with increasing age, severity of disease and as a result of drug therapy, sometimes for associated disorders. " 08/01/2011 - "Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management." 10/01/2009 - "Elderly patients also have variable responses to HF pharmacotherapy and might be susceptible to adverse events, such as orthostatic hypotension, renal dysfunction, electrolyte disturbances, and interactions with medications being received for the treatment of comorbidities. " 04/01/2008 - "Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension."
4.	Bed Rest (Bedrest) 07/01/2000 - "The purpose of the present study is to examine the changes in the arterial baroreflex control of muscle sympathetic nerve activity (MSNA) after head-down bed rest (HDBR), in relation to orthostatic hypotension after HDBR. " 07/01/2007 - "The preservation of cerebral blood flow with orthostatic hypotension (e.g., following prolonged bed rest or microgravity exposure) is vital for the attenuation of symptoms and the maintenance of consciousness. " 02/01/2005 - "Fluid loading at the end of bed rest restored plasma volume and resulted in the absence of post-bed-rest orthostatic hypotension and changes in supine hemodynamic and endocrine variables. " 09/01/2004 - "She had persistent postural hypotension lasting for about 24 hours requiring bed rest and was discharged about 36 hours after the procedure, without any adverse sequelae. " 12/01/2003 - "Bed-rest > 12 hours produced postural hypotension (PH) in 54% of seated older inpatients. "
5.	Lower Body Negative Pressure 09/01/2006 - "The objective of this study was to evaluate the use of LBNP for detecting drug-induced changes in susceptibility to orthostatic hypotension in conscious monkeys (Macaca fascicularis). " 09/01/2006 - "Methods most commonly used for detecting susceptibility to orthostatic hypotension in humans include head-up tilt and the application of lower body negative pressure (LBNP). " 09/01/2006 - "A model of orthostatic hypotension in the conscious monkey using lower body negative pressure." 01/01/1998 - "Endurance-trained males may be more prone to orthostatic hypotension than untrained subjects and this is reflected in differences in their cardiovascular responses to lower body negative pressure (LBNP). " 05/01/1994 - "Thus, there are numerous drugs that, in combination with mechanical techniques, including lower body negative pressure to elevate transmural pressure, could be studied to treat orthostatic hypotension after space flight."