Epidemiology, Diagnosis, and Management of Neurogenic Orthostatic Hypotension

Abstract

Background: Orthostatic hypotension (OH) is a sustained fall in blood pressure on standing that can cause symptoms of organ hypoperfusion. OH is associated with increased morbidity and mortality and leads to a significant number of hospital admissions, particularly in the elderly (233 per 100,000 patients >75 years of age in the United States). OH can result from volume depletion, blood loss, large varicose veins, medications, or because of defective activation of sympathetic nerves and reduced norepinephrine release on standing (i.e., neurogenic OH). Methods and Findings: A literature review shows that neurogenic OH is a frequent and disabling problem in patients with synucleinopathies such as Parkinson's disease, multiple system atrophy, and pure autonomic failure, and it is commonly associated with supine hypertension. Several pharmacological and nonpharmacological therapeutic options are available. Conclusions: Here we review the epidemiology, diagnosis, and management of neurogenic OH, and provide an algorithm for its treatment, emphasizing the importance of removing aggravating factors, implementing nonpharmacologic measures, and selecting appropriate pharmacological treatments.