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Diagnosis and management of neurogenic orthostatic hypotension

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초록

Orthostatic hypotension is a sustained and pathological drop in blood pressure upon standing. Orthostatic hypotension can be due to non-neurogenic conditions or autonomic disorders. Impaired baroreflex-mediated vasoconstriction and insufficient release of norepinephrine play key roles in the pathophysiology of neurogenic orthostatic hypotension. Its common symptoms mainly related to inadequate cerebral blood flow include dizziness, lightheadedness, and syncope. It is crucial to differentiate neurogenic orthostatic hypotension from non-neurogenic orthostatic hypotension. For the management of neurogenic orthostatic hypotension, physicians should implement non-pharmacological methods and, if possible, reverse combined non-neurological conditions. Depending on severity of symptoms, pharmacological intervention may be tried after or with non-pharmacological methods. Its management should be individualized based on intensity of symptoms, comorbid conditions, drug side effects, and etiology. In this review, we discuss the definition, pathophysiology, clinical approach, and management of neurogenic orthostatic hypotension

Abstract

Orthostatic hypotension is a sustained and pathological drop in blood pressure upon standing. Orthostatic hypotension can be due to non-neurogenic conditions or autonomic disorders. Impaired baroreflex-mediated vasoconstriction and insufficient release of norepinephrine play key roles in the pathophysiology of neurogenic orthostatic hypotension. Its common symptoms mainly related to inadequate cerebral blood flow include dizziness, lightheadedness, and syncope. It is crucial to differentiate neurogenic orthostatic hypotension from non-neurogenic orthostatic hypotension. For the management of neurogenic orthostatic hypotension, physicians should implement non-pharmacological methods and, if possible, reverse combined non-neurological conditions. Depending on severity of symptoms, pharmacological intervention may be tried after or with non-pharmacological methods. Its management should be individualized based on intensity of symptoms, comorbid conditions, drug side effects, and etiology. In this review, we discuss the definition, pathophysiology, clinical approach, and management of neurogenic orthostatic hypotension

참고문헌 (91)

  1. Robertson D, "The pathophysiology and diagnosis of orthostatic hypotension", Clin Auton Res, 18, pp.2~7 (2008)
  2. Shibao C, "Evaluation and treatment of orthostatic hypotension", J Am Soc Hypertens, 7, pp.317~324 (2013)
  3. Wieling W, "Diagnosis and treatment of orthostatic hypotension", Lancet Neurol, 21, pp.735~746 (2022)
  4. Low PA, "Management of neurogenic orthostatic hypotension : an update", Lancet Neurol, 7, pp.451~458 (2008)
  5. Lanfranchi PA, "Arterial baroreflex function and cardiovascular variability : interactions and implications", Am J Physiol Regul Integr Comp Physiol, 283, pp.R815~R826 (2002)
  6. Magkas N, "Orthostatic hypotension : from pathophysiology to clinical applications and therapeutic considerations", J Clin Hypertens(Greenwich), 21, pp.546~554 (2019)
  7. Kanjwal K, "Orthostatic hypotension : definition, diagnosis and management", J Cardiovasc Med(Hagerstown), 16, pp.75~81 (2015)
  8. Freeman R, "Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome", Clin Auton Res, 21, pp.69~72 (2011)
  9. Gibbons CH, "The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension", J Neurol, 264, pp.1567~1582 (2017)
  10. Freeman R, "Orthostatic hypotension : JACC state-of-the-art review", J Am Coll Cardiol, 72, pp.1294~1309 (2018)
  11. Tzur I, "Delayed versus classic orthostatic hypotension : clinical and prognostic implications", Blood Press, 29, pp.209~219 (2020)
  12. Brignole M, "Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope", Eur Heart J, 39, pp.e43~ (2018)[DOI]
  13. Gibbons CH, "Clinical implications of delayed orthostatic hypotension : a 10-year follow-up study", Neurology, 85, pp.1362~1367 (2015)
  14. Byun JI, "Delayed orthostatic hypotension : severity of clinical symptoms and response to medical treatment", Auton Neurosci, 213, pp.81~85 (2018)
  15. van Wijnen VK, "Initial orthostatic hypotension in teenagers and young adults", Clin Auton Res, 26, pp.441~449 (2016)
  16. Wieling W, "Initial orthostatic hypotension : review of a forgotten condition", Clin Sci(Lond), 112, pp.157~165 (2007)
  17. Vinik AI, "Diabetic cardiovascular autonomic neuropathy", Circulation, 115, pp.387~397 (2007)
  18. Finucane C, "Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls", J Am Geriatr Soc, 65, pp.474~482 (2017)
  19. Doyle K, "Delayed blood pressure recovery after standing independently predicts fracture in community-dwelling older people", J Am Med Dir Assoc, 22, pp.1235~1241 (2021)
  20. Mol A, "Orthostatic blood pressure recovery associates with physical performance, frailty and number of falls in geriatric outpatients", J Hypertens, 39, pp.101~106 (2021)
  21. van Twist DJL, "Delayed recovery from initial orthostatic hypotension : an expression of frailty in the elderly", Clin Auton Res, 30, pp.105~106 (2020)
  22. Centi J, "Effects of orthostatic hypotension on cognition in Parkinson disease", Neurology, 88, pp.17~24 (2017)
  23. Robertson D, "The head and neck discomfort of autonomic failure : an unrecognized aetiology of headache", Clin Auton Res, 4, pp.99~103 (1994)
  24. Bleasdale-Barr KM, "Neck and other muscle pains in autonomic failure : their association with orthostatic hypotension", J R Soc Med, 91, pp.355~359 (1998)
  25. Gibbons CH, "Orthostatic dyspnea : a neglected symptom of orthostatic hypotension", Clin Auton Res, 15, pp.40~44 (2005)
  26. Palma JA, "Orthostatic hypotension in Parkinson disease: how much you fall or how low you go?", Mov Disord, 30, pp.639~645 (2015)
  27. Freeman R, "Symptom recognition is impaired in patients with orthostatic hypotension", Hypertension, 75, pp.1325~1332 (2020)
  28. Arbogast SD, "Hypotension unawareness in profound orthostatic hypotension", Am J Med, 122, pp.574~580 (2009)
  29. Shaw BH, "Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a ‘sit-to-stand test’", J Hypertens, 35, pp.1019~1025 (2017)
  30. Cremer A, "Screening for orthostatic hypotension using home blood pressure measurements", J Hypertens, 37, pp.923~927 (2019)
  31. Gibbon JR, "Feasibility, reliability and safety of self-assessed orthostatic blood pressure at home", Age Ageing, 51, pp.afac153~ (2022)
  32. Norcliffe-Kaufmann L, "Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies", Ann Neurol, 83, pp.522~531 (2018)
  33. Lamotte G, "Updates on the diagnosis and treatment of peripheral autonomic neuropathies", Curr Neurol Neurosci Rep, 22, pp.823~837 (2022)
  34. Freeman R, "Autonomic peripheral neuropathy", Neurol Clin, 25, pp.277~301 (2007)
  35. Zaeem Z, "Autonomic involvement in Guillain-Barré syndrome : an update", Clin Auton Res, 29, pp.289~299 (2019)
  36. Palma JA, "Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis and management", Clin Auton Res, 29, pp.33~44 (2019)
  37. Goldstein DS, "Neurogenic orthostatic hypotension : a pathophysiological approach", Circulation, 119, pp.139~146 (2009)
  38. Mendoza-Velásquez JJ, "Autonomic dysfunction in α-synucleinopathies", Front Neurol, 10, pp.363~ (2019)
  39. Harms MP, "Continuous stroke volume monitoring by modelling flow from non-invasive measurement of arterial pressure in humans under orthostatic stress", Clin Sci(Lond), 97, pp.291~301 (1999)
  40. Idiaquez JF, "Neurogenic orthostatic hypotension. Lessons from synucleinopathies", Am J Hypertens, 34, pp.125~133 (2021)
  41. Smit AA, "Pathophysiological basis of orthostatic hypotension in autonomic failure", J Physiol, 519, pp.1~10 (1999)
  42. Benarroch EE., "The central autonomic network: functional organization, dysfunction, and perspective", Mayo Clin Proc, 68, pp.988~1001 (1993)
  43. Cryer PE, "Reduced plasma norepinephrine response to standing in autonomic dysfunction", Arch Neurol, 33, pp.275~277 (1976)
  44. Mantovani G, "Supine hypertension : a state of the art", Auton Neurosci, 241, pp.102988~ (2022)
  45. Fanciulli A, "Supine hypertension in Parkinson’s disease and multiple system atrophy", Clin Auton Res, 26, pp.97~105 (2016)
  46. Jordan J, "What do we really know about supine hypertension in patients with orthostatic hypotension", Curr Opin Cardiol, 34, pp.384~389 (2019)
  47. Fanciulli A, "Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society(AAS)and the European Federation of Autonomic Societies(EFAS) : endorsed by the European Academy of Neurology(EAN)and the European Society of Hypertension(ESH)", Clin Auton Res, 28, pp.355~362 (2018)
  48. Jordan J, "Management of supine hypertension in patients with neurogenic orthostatic hypotension: scientific statement of the American Autonomic Society, European Federation of Autonomic Societies, and the European Society of Hypertension", J Hypertens, 37, pp.1541~1546 (2019)
  49. Biaggioni I, "Primer on the autonomic nervous system", pp.699~704 (2023), Elsevier
  50. Ando Y, "Autonomic dysfunction and anemia in neurologic disorders", J Auton Nerv Syst, 61, pp.145~148 (1996)
  51. Bolek H, "Orthostatic hypotension among elderly patients in Italian internal medicine wards : an observational study-comment", Intern Emerg Med, 15, pp.1353~1354 (2020)
  52. Wieling W, "Physical countermeasures to increase orthostatic tolerance", J Intern Med, 277, pp.69~82 (2015)
  53. Palma JA, "Management of orthostatic hypotension", Continuum(Minneap Minn), 26, pp.154~177 (2020)
  54. van Dijk N, "Hemodynamic effects of leg crossing and skeletal muscle tensing during free standing in patients with vasovagal syncope", J Appl Physiol(1985), 98, pp.584~590 (2005)
  55. Krediet CT, "Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output", J Appl Physiol(1985), 99, pp.1697~1703 (2005)
  56. Wilcox CS, "Sodium homeostasis in patients with autonomic failure", Clin Sci Mol Med, 53, pp.321~328 (1977)
  57. Williams EL, "Salt supplementation in the management of orthostatic intolerance : vasovagal syncope and postural orthostatic tachycardia syndrome", Auton Neurosci, 237, pp.102906~ (2022)
  58. Stock JM, "Dietary sodium and health: how much is too much for those with orthostatic disorders?", Auton Neurosci, 238, pp.102947~ (2022)
  59. Mtinangi BL, "Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope", Clin Auton Res, 8, pp.231~235 (1998)
  60. Snapper H, "Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome", Auton Neurosci, 238, pp.102951~ (2022)
  61. Jordan J, "The pressor response to water drinking in humans : a sympathetic reflex?", Circulation, 101, pp.504~509 (2000)
  62. Lipp A, "Osmosensitive mechanisms contribute to the water drinking-induced pressor response in humans", Neurology, 65, pp.905~907 (2005)
  63. McHugh J, "Portal osmopressor mechanism linked to transient receptor potential vanilloid 4 and blood pressure control", Hypertension, 55, pp.1438~1443 (2010)
  64. May M, "The osmopressor response to water drinking", Am J Physiol Regul Integr Comp Physiol, 300, pp.R40~R46 (2011)
  65. Podoleanu C, "Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons : a randomized single-blind controlled study", J Am Coll Cardiol, 48, pp.1425~1432 (2006)
  66. Ricci F, "Orthostatic hypotension:epidemiology, prognosis, and treatment", J Am Coll Cardiol, 66, pp.848~860 (2015)
  67. Bourne KM, "Compression garment reduces orthostatic tachycardia and symptoms in patients with postural orthostatic tachycardia syndrome", J Am Coll Cardiol, 77, pp.285~296 (2021)
  68. Lahrmann H, "EFNS guidelines on the diagnosis and management of orthostatic hypotension", Eur J Neurol, 13, pp.930~936 (2006)
  69. Figueroa JJ, "Preventing and treating orthostatic hypotension: as easy as A, B, C", Cleve Clin J Med, 77, pp.298~306 (2010)
  70. Shibao C, "ASH position paper : evaluation and treatment of orthostatic hypotension", J Clin Hypertens(Greenwich), 15, pp.147~153 (2013)
  71. Wright RA, "A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension", Neurology, 51, pp.120~124 (1998)
  72. Jankovic J, "Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine", Am J Med, 95, pp.38~48 (1993)
  73. Low PA, "Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension. A randomized, double-blind multicenter study", JAMA, 277, pp.1046~1051 (1997)
  74. Smith W, "Clinical benefit of midodrine hydrochloride in symptomatic orthostatic hypotension:a phase 4, double-blind, placebo-controlled, randomized, tilt-table study", Clin Auton Res, 26, pp.269~277 (2016)
  75. Ten Harkel AD, "Treatment of orthostatic hypotension with sleeping in the head-up tilt position, alone and in combination with fludrocortisone", J Intern Med, 232, pp.139~145 (1992)
  76. Pavy-Le Traon A, "Ambulatory blood pressure and drug treatment for orthostatic hypotension as predictors of mortality in patients with multiple system atrophy", Eur J Neurol, 29, pp.1025~1034 (2022)
  77. Grijalva CG, "Fludrocortisone is associated with a higher risk of all-cause hospitalizations compared with midodrine in patients with orthostatic hypotension", J Am Heart Assoc, 6, pp.e006848~ (2017)
  78. Palma JA, "Supine plasma NE predicts the pressor response to droxidopa in neurogenic orthostatic hypotension", Neurology, 91, pp.e1539~e1544 (2018)
  79. Biaggioni I, "Randomized withdrawal study of patients with symptomatic neurogenic orthostatic hypotension responsive to droxidopa", Hypertension, 65, pp.101~107 (2015)
  80. Kaufmann H, "Droxidopa for neurogenic orthostatic hypotension:a randomized, placebo-controlled, phase 3 trial", Neurology, 83, pp.328~335 (2014)
  81. Hauser RA, "Droxidopa for the short-term treatment of symptomatic neurogenic orthostatic hypotension in Parkinson’s disease(nOH306B)", Mov Disord, 30, pp.646~654 (2015)
  82. Hauser RA, "Durability of the clinical benefit of droxidopa for neurogenic orthostatic hypotension during 12 weeks of open-label treatment", Neurol Ther, 11, pp.459~469 (2022)
  83. Owen R, "Rationale and design of the neurogenic orthostatic hypotension to assess sustained effects of droxidopa therapy (RESTORE) study (P5. 131)", Neurology, 86, pp.131~ (2016)
  84. Shibao CA, "Predictors of the pressor response to the norepinephrine transporter inhibitor, atomoxetine, in neurogenic orthostatic hypotension", Hypertension, 78, pp.525~531 (2021)
  85. Ramirez CE, "Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure", Hypertension, 64, pp.1235~1240 (2014)
  86. Kaufmann H, "Safety and efficacy of ampreloxetine in symptomatic neurogenic orthostatic hypotension : a phase 2trial", Clin Auton Res, 31, pp.699~711 (2021)
  87. Palma JA, "Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension", Mov Disord Clin Pract, 4, pp.298~308 (2017)
  88. Lamotte G, "Orthostatic hypotension in parkinson disease : what is new?", Neurol Clin Pract, 12, pp.e112~e115 (2022)
  89. Singer W, "Pyridostigmine treatment trial in neurogenic orthostatic hypotension", Arch Neurol, 63, pp.513~518 (2006)
  90. Schreglmann SR, "Pyridostigmine bromide versus fludrocortisone in the treatment of orthostatic hypotension in Parkinson’s disease-a randomized controlled trial", Eur J Neurol, 24, pp.545~551 (2017)
  91. Okamoto LE, "Synergistic pressor effect of atomoxetine and pyridostigmine in patients with neurogenic orthostatic hypotension", Hypertension, 73, pp.235~241 (2019)

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