Pharmacologic treatment of orthostatic hypotension.
Orthostatic hypotension
Pharmacologic treatment
Journal
Autonomic neuroscience : basic & clinical
ISSN: 1872-7484
Titre abrégé: Auton Neurosci
Pays: Netherlands
ID NLM: 100909359
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
25
03
2020
revised:
18
08
2020
accepted:
23
08
2020
pubmed:
27
9
2020
medline:
6
10
2021
entrez:
26
9
2020
Statut:
ppublish
Résumé
Neurogenic orthostatic hypotension (OH) is a disabling disorder caused by impairment of the normal autonomic compensatory mechanisms that maintain upright blood pressure. Nonpharmacologic treatment is always the first step in the management of this condition, but a considerable number of patients will require pharmacologic therapies. Denervation hypersensitivity and impairment of baroreflex buffering makes these patients sensitive to small doses of pressor agents. Understanding the underlying pathophysiology can help in selecting between treatment options. In general, patients with low "sympathetic reserve", i.e., those with peripheral noradrenergic degeneration (pure autonomic failure, Parkinson's disease) and low plasma norepinephrine, tend to respond better to "norepinephrine replacers" (midodrine and droxidopa). On the other hand, patients with relatively preserved "sympathetic reserve", i.e., those with impaired central autonomic pathways but spared peripheral noradrenergic fibers (multiple system atrophy) and normal or slightly reduced plasma norepinephrine, tend to respond better to "norepinephrine enhancers" (pyridostigmine, atomoxetine, and yohimbine). There is, however, a spectrum of responses within these extremes, and treatment should be individualized. Other nonspecific treatments include fludrocortisone and octreotide. The presence of associated clinical conditions, such as supine hypertension, heart failure, postprandial hypotension, PD, MSA, and diabetes need to be considered in the pharmacologic management of these patients.
Identifiants
pubmed: 32979782
pii: S1566-0702(20)30155-7
doi: 10.1016/j.autneu.2020.102721
pmc: PMC7704612
mid: NIHMS1631986
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
102721Subventions
Organisme : FDA HHS
ID : R01 FD004778
Pays : United States
Organisme : NINDS NIH HHS
ID : U54 NS065736
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL144568
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL122847
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL149386
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
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