Orthostatic Hypotension: Mechanisms, Causes, Management
2
조회
0
다운로드
10
인용
0
참고문헌
키워드
초록
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. Tere are many causes of OH. Aging coupled with diseases such as diabetes and Parkinson’s disease results in a prevalence of 10–30% in the elderly. Tese conditions cause barorefex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP. Te 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. We provide a pragmatic guide on patient education and the patient-orientated approach to the moment to moment management of OH.
Abstract
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. Tere are many causes of OH. Aging coupled with diseases such as diabetes and Parkinson’s disease results in a prevalence of 10–30% in the elderly. Tese conditions cause barorefex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP. Te 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. We provide a pragmatic guide on patient education and the patient-orientated approach to the moment to moment management of OH.
참고문헌 (35)
- Low PA, "Update on the evaluation, pathogenesis, and management of neurogenic orthostatic hypotension: introduction", Neurology, 45, pp.S4~S5 (1995)
- Thieben MJ, "Postural orthostatic tachycardia syndrome: the Mayo clinic experience", Mayo Clin Proc, 82, pp.308~313 (2007)
- "Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology", Neurology, 46, pp.1470~ (1996)
- Low PA, "Prevalence of orthostatic hypotension", Clin Auton Res, 18(1), pp.8~13 (2008)
- Low PA, "Management of neurogenic orthostatic hypotension:an update", Lancet Neurol, 7, pp.451~458 (2008)
- Low PA, "The sympathetic nervous system in diabetic neuropathy. A clinical and pathological study", Brain, 98, pp.341~356 (1975)
- Fujimura J, "Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension", J Auton Nerv Syst, 67, pp.15~23 (1997)
- Lipp A, "Prospective differentiation of multiple system atrophy from Parkinson disease, with and without autonomic failure", Arch Neurol, 66, pp.742~750 (2009)
- Thaisetthawatkul P, "Autonomic dysfunction in dementia with Lewy bodies", Neurology, 62, pp.1804~1809 (2004)
- Low PA, "The sympathetic nervous system in alcoholic neuropathy. A clinical and pathological study", Brain, 98, pp.357~364 (1975)
- Ketch T, "Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia", Circulation, 105, pp.2518~2523 (2002)
- Low PA, "Quantitative sudomotor axon reflex test in normal and neuropathic subjects", Ann Neurol, 14, pp.573~580 (1983)
- Low PA, "Autonomic nervous system function", J Clin Neurophysiol, 10, pp.14~27 (1993)
- Low PA, "Laboratory evaluation of autonomic function", Suppl Clin Neurophysiol, 57, pp.358~368 (2004)
- Denq JC, "Normative data on phases of the Valsalva maneuver", J Clin Neurophysiol, 15, pp.535~540 (1998)
- Fealey RD, "Thermoregulatory sweating abnormalities in diabetes mellitus", Mayo Clin Proc, 64, pp.617~628 (1989)
- El-Sayed H, "Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope", Heart, 75, pp.134~140 (1996)
- Low PA, "Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension. A randomized, double-blind multicenter study", JAMA, 277, pp.1046~1051 (1997), Midodrine Study Group
- Figueroa JJ, "Preventing and treating orthostatic hypotension: as easy as A, B, C", Cleve Clin J Med, 77, pp.298~306 (2010)
- Smit AA, "Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction", Clin Auton Res, 14, pp.167~175 (2004)
- Denq JC, "Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension", Clin Auton Res, 7, pp.321~326 (1997)
- Jordan J, "A potent pressor response elicited by drinking water", Lancet, 353, pp.723~ (1999)
- Jordan J, "The pressor response to water drinking in humans: a sympathetic reflex?", Circulation, 101, pp.504~509 (2000)
- Bouvette CM, "Role of physical countermaneuvers in the management of orthostatic hypotension:efficacy and biofeedback augmentation", Mayo Clin Proc, 71, pp.847~853 (1996)
- Maule S, "Orthostatic hypotension: evaluation and treatment", Cardiovasc Hematol Disord Drug Targets, 7, pp.63~70 (2007)
- Kaufmann H, "Droxidopa for neurogenic orthostatic hypotension: a randomized, placebo-controlled, phase 3 trial", Neurology, 83, pp.328~335 (2014)
- Singer W, "Pyridostigmine treatment trial in neurogenic orthostatic hypotension", Arch Neurol, 63, pp.513~518 (2006)
- Shibao C, "Management of hypertension in the setting of autonomic failure: a pathophysiological approach", Hypertension, 45, pp.469~476 (2005)
- Rodstein M, "Postural blood pressure changes in the elderly", J Chronic Dis, 6, pp.581~588 (1957)
- Caird FI, "Effect of posture on blood pressure in the elderly", Br Heart J, 35, pp.527~530 (1973)
- Myers MG, "Postural hypotension and diuretic therapy in the elderly", Can Med Assoc J, 119, pp.581~585 (1978)
- MacLennan WJ, "Postural hypotension in old age:is it a disorder of the nervous system or of blood vessels?", Age Ageing, 9, pp.25~32 (1980)
- Lennox IM, "Postural hypotension in the elderly", Clin Exp Gerontol, 2, pp.313~329 (1980)
- Palmer KT, "Studies into postural hypotension in elderly patients", N Z Med J, 96, pp.43~45 (1983)
- Mader SL, "Low prevalence of postural hypotension among community-dwelling elderly", JAMA, 258, pp.1511~1514 (1987)