Management of neurogenic orthostatic hypotension: an update.

Abstract

Orthostatic hypotension (OH) is common in elderly people and in patients with disorders such as diabetes and Parkinson's disease. Grading of the severity of OH and its effect on the patient's quality of life are important. The symptoms vary with orthostatic stress, and subtle symptoms such as tiredness and cognitive impairment should be recognised. Standard drug treatment for OH is effective but worsens supine hypertension, whereas pyridostigmine can improve OH slightly but significantly without worsening of supine hypertension. Because orthostatic stress varies from moment to moment and drug treatment is suboptimal, drug treatment of OH needs to be combined with non-pharmacological approaches, such as compression of venous capacitance beds, use of physical counter-manoeuvres, and intermittent water-bolus treatment.

• Authors: Phillip A Low, Wolfgang Singer
• Journal: The Lancet. Neurology (Lancet Neurol) Vol. 7 Issue 5 Pg. 451-8 (May 2008) ISSN: 1474-4422 [Print] England
• PMID: 18420158 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Cholinesterase Inhibitors

Topics

• Baroreflex (drug effects, physiology)
• Cholinesterase Inhibitors (therapeutic use)
• Humans
• Hypotension, Orthostatic (diagnosis, physiopathology, therapy)
• Peripheral Nerves (drug effects, physiopathology)