Orthostatic hypotension is defined as an episode of sudden blood pressure (BP) drop, in three or fewer minutes after assuming a standing position, when one was previously lying supine or sitting. In order for the episode to be substantiated as orthostatic hypotension, the BP decrease should amount to 20 mmHg or more in the systolic blood pressure or to 10 mmHg or more in the diastolic blood pressure. In some cases, both the systolic and diastolic blood pressure drop.

Some OH cases are asymptomatic and do remain undiagnosed. Symptomatic OH produces typical symptoms that vary in terms of severity. One of the most commonly reported symptoms is light-headedness and dizziness [1]. A 2014 study reported that 20% of the patients with orthostatic hypotension felt light-headed when standing up. Considerable weakness, nausea, blurred vision and disorientation are also frequently reported symptoms. Fainting is a manifestation of orthostatic hypotension that is significantly severer than the aforementioned ones, although it is less common. The clinical picture is completed by the onset of headaches, shoulder ache or neck pain and chest tightness or dyspnea, on some occasions [2]. The most debilitating effect that OH can exert on a patient is generalized seizures, which have been rarely described. Some individuals experience an aggravation of the symptoms following a heavy meal or physical exercise.

Orthostatic hypotension typically affects senior citizens, even though it is not uncommon amongst the younger population [3] [4] [5].

• Falling

  Falls were prospectively registered. Cox proportional hazard modelling and the conditional frailty model were used to analyse the relationship between OH and (recurrent) falling. [ncbi.nlm.nih.gov]

• Fatigue

  It is noteworthy that 91% of INOH patients had complaints of chronic fatigue and that 40 (37%) of 107 children with chronic fatigue were diagnosed as having INOH. [nature.com]

  The patient is a 76 year-old woman who presented with progressive dizziness, anorexia, and fatigue. She had severe orthostatic hypotension (supine systolic blood pressure 186 mmHg and standing 79 mmHg). [ncbi.nlm.nih.gov]

• Anemia

  After administration of subcutaneous erythropoietin, his blood pressure drop in the upright position was decreased and symptoms disappeared unassociated with improvement of anemia. [ncbi.nlm.nih.gov]

  Historical Clues to Diagnosis of Orthostatic Hypotension Historical features Possible etiology Abnormal uterine bleeding, fatigue, rectal bleeding Anemia Amaurosis fugax, aphasia, dysarthria, unilateral sensory and motor symptoms Stroke Bradykinesia, [aafp.org]

• Movement Disorder

  Author information 1 Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 2 L.C. [ncbi.nlm.nih.gov]

  “Orthostatic Hypotension in Parkinson’s Disease, Multiple System Atrophy, and Lewy Body Dementia” By the Stanford Movement Disorder Center and Brain Support Network, September 18, 2017 Movement disorder specialist, Dr. [parkinsons.stanford.edu]

  Physicians, specifically movement disorders specialists, are trained to know the best treatments for hypotension for PD patients and whether treatments for PD symptoms are causing hypotension. [parkinsonsdisease.net]

• Pallor

  Throughout the procedure, assess her for signs and symptoms of hypotension, including dizziness, light-headedness, pallor, diaphoresis, or syncope (or arrhythmias if she's attached to a cardiac monitor). [journals.lww.com]

  Report all findings to the treating medical provider, including all sets of blood pressure and pulse results, and whether the patient experienced pallor, diaphoresis, or faintness when upright. [ahrq.gov]

  Their symptoms may include most of the symptoms of acute OI, plus: Nausea Neurocognitive deficits, such as attention problems Pallor Sensitivity to heat Sleep problems Other vasomotor symptoms. [1] Causes [ edit ] Symptoms of OI are triggered by the following [en.wikipedia.org]

  When patients showed near-fainting symptoms of dizziness, nausea, sweating, and pallor, the test was immediately stopped and the patients were returned to the supine position. [nature.com]

• Nausea

  Considerable weakness, nausea, blurred vision and disorientation are also frequently reported symptoms. Fainting is a manifestation of orthostatic hypotension that is significantly severer than the aforementioned ones, although it is less common. [symptoma.com]

  Other associated symptoms include neurocognitive or sleep disorders, exercise intolerance, hyperpnea, dyspnea, nausea, abdominal pain, and sweating. [emedicine.medscape.com]

  The most common side effects with NORTHERA are headache, dizziness, nausea, and high blood pressure. Taking NORTHERA with other medications may cause side effects. [northera.com]

  The most common symptoms include headache, nausea, vomiting, blurred vision, and imbalance. The typical appearance on cranial magnetic resonance imaging is hyper-intensity on T2-weighted images and hypo-intensity on T1-weighted images. [go.gale.com]

  Symptoms may include: Blurry vision Dizziness Light-headedness Mental confusion Nausea Muscle tremors Fainting. [betterhealth.vic.gov.au]

• Hypotension

  Orthostatic hypotension is otherwise known as postural hypotension, since a change of posture is responsible for the sudden-onset episode of decreased blood pressure. [symptoma.com]

  […] of orthostatic hypotension. [aafp.org]

  Orthostatic hypotension can cause falling and syncope. [consultant360.com]

• Chronic Hypotension

  INTRODUCTION: Midlife hypertension is associated with dementia in longitudinal studies while chronic hypotension in the elderly is associated with dementia onset. Orthostatic hypotension could influence cognitive performance in the elderly. [ncbi.nlm.nih.gov]

  Chronic hypotension Primary acquired disease of the adrenals: Addison's disease (autoimmune adrenal failure). This is perhaps the best remembered cause of hypotension. [patient.info]

  Chronic hypotension: in the shadow of hypertension. Am J Hypertens. 1992 ; 5 :200S–205S. Crossref Medline Google Scholar 16 Ray Chaudhuri K, Maule S, Thomaides T, Pavitt D, Mathias CJ. [doi.org]

• Shoulder Pain

  Less common symptoms include syncope, dyspnea, chest pain, and neck and shoulder pain. Causes include dehydration or blood loss; disorders of the neurologic, cardiovascular, or endocrine systems; and several classes of medications. [aafp.org]

  Other common symptoms include: nausea palpitations headache weakness confusion blurred vision Less common symptoms, according to American Family Physician, can include: fainting chest pain neck and shoulder pain How is orthostatic hypotension diagnosed [healthline.com]

  Less common symptoms include syncope, dyspnoea, chest pain and neck and shoulder pain [ 5 ]. The most common causes are medications and conditions that cause hypovolaemia, such as blood or fluid loss, diuretic or vasodilator therapy [ 6 ]. [patient.info]

• Sweating

  A detailed medical history is necessary, including symptoms elicited by OH, medications that the patient is taking and autonomic failure indications, such as severe constipation, incontinence, irregular sweating or tingling sensation of the feet. [symptoma.com]

  Decreased sweating manifests as heat or exercise intolerance. Patients may have noticeably warm and/or dry skin. The eyes may be affected. [emedicine.medscape.com]

  Certain medications can cause orthostatic hypotension, as can dehydration due to vomiting, diarrhea, untreated diabetes, or excessive sweating. [kidshealth.org]

  Other common symptoms include difficulty swallowing, severe vomiting or gastroesophageal reflux, poor muscle tone, excessive sweating, overproduction of saliva and mucus, and blotchy reddening of the skin when excited or eating. [nyulangone.org]

  Fever, vomiting, not drinking enough fluids, severe diarrhea and strenuous exercise with excessive sweating can all lead to dehydration, which decreases blood volume. [mayoclinic.org]

• Anhidrosis

  […] lightheadedness, syncope, and other symptoms of cerebral hypoperfusion Other Factors parkinsonian features cerebellar ataxia weight loss resting tachycardia or impaired heart rate variation abnormal GI motility erectile dysfunction and lack of ejaculation anhidrosis [online.epocrates.com]

  Adverse effects include diarrhea, constipation, anhidrosis, abdominal cramps, sialorrhea, urinary incontinence, and excessive sweating. [cureus.com]

  A thorough evaluation might involve an autonomic reflex screen (to evaluate adrenergic, sudomotor and cardiovagal function), thermoregulatory sweat test (to evaluate the distribution of anhidrosis), tests for an autonomic neuropathy (such as diabetes, [rarediseases.org]

  A sweat test showed about 50% anhidrosis. Norepinephrine level was about 30 units lower supine than upright. He was diagnosed as having neurogenic orthostatic hypotension. [tchain.com]

• Hyperhidrosis

  […] cerebral hypoperfusion Other Factors parkinsonian features cerebellar ataxia weight loss resting tachycardia or impaired heart rate variation abnormal GI motility erectile dysfunction and lack of ejaculation anhidrosis, heat intolerance, dry skin, focal hyperhidrosis [online.epocrates.com]

  […] blackening and tunnel vision); syncope; hearing disturbances (including impaired hearing, crackles and tinnitus); pain in the neck (occipital/paracervical and shoulder region), low back pain or precordial pain; weakness, fatigue, lethargy; palpitations and hyperhidrosis [escardio.org]

• Dizziness

  AIMS: The aim of this study was to assess the involvement of the irregularity of the vertical perception in the dizzy elderly with OH. METHODS: This study consisted of 403 patients seeking treatment for dizziness in our hospital. [ncbi.nlm.nih.gov]

  "If someone comes into the clinic with dizziness, we try to assess his/her risk of falling or other consequences of dizziness in the future," says Juraschek. [news-medical.net]

  Ask patient about dizziness, weakness, or visual changes associated with position change. Note diaphoresis or pallor. Check sitting blood pressure and pulse. [ahrq.gov]

  DON'T Don't leave the patient unassisted during position changes if she develops dizziness or light-headedness. Don't have her stand if she develops signs and symptoms of hypotension, such as dizziness, light-headedness, or pallor while sitting. [journals.lww.com]

• Headache

  The patient was admitted to the emergency department of a local hospital within two days due to ongoing headache, elevated temperature, and nuchal rigidity, symptoms suggestive of meningitis. [ncbi.nlm.nih.gov]

  The clinical picture is completed by the onset of headaches, shoulder ache or neck pain and chest tightness or dyspnea, on some occasions. [symptoma.com]

  The most common symptoms include headache, nausea, vomiting, blurred vision, and imbalance. The typical appearance on cranial magnetic resonance imaging is hyper-intensity on T2-weighted images and hypo-intensity on T1-weighted images. [go.gale.com]

• Vertigo

  The most common symptoms of orthostatic hypotension include weakness, lightheadedness, cognitive impairment, blurred vision, vertigo and tremulousness. [encyclopedia.com]

  Twenty-seven of these 55 cases (i.e. 46%) were symptomatic, i.e. associated with at least one of the clinical symptoms of orthostatism (lightheadedness, general weakness, visual disturbance, dizziness, vertigo, malaise, falls, etc.). [pitt.edu]

  Also see Vertigo. [1] M. Eigenbrodt et al [2] 沈漁﹐.精神病學，第3版，北京:人民衛生出版社，1994，11. Sponsors' Ads by Google 以下為谷歌 所提供之廣告 [alternativehealing.org]

  Some also report difficulty concentrating, blurred vision, tremulousness, vertigo, anxiety, palpitations (awareness of the heartbeat), unsteadiness, feeling sweaty or clammy, and sometimes nausea. [en.wikipedia.org]

• Guillain-Barré Syndrome

  Dysautonomia is commonly observed in Guillain-Barré syndrome (GBS). However, hypotension is rarely a presenting and persisting symptom. [ncbi.nlm.nih.gov]

  Neurogenic orthostatic hypotension often occurs along with nervous system disorders such as Parkinson disease, dementia with Lewy bodies, multiple system atrophy, pure autonomic failure, diabetes, Guillain-Barré syndrome, dopamine beta-hydroxylase deficiency [ghr.nlm.nih.gov]

  […] symptoms Pure autonomic failure Parkinsonian features, urinary incontinence or retention, cerebellar dysfunction, autonomic symptoms Multiple system atrophy Dysautonomia of acute onset or occurring over a few weeks (can occur with supine hypertension) Guillain-Barré [aafp.org]

  Examples include Sjögren syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain–Barré syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves. Diagnosis[edit] This section is empty. [en.wikipedia.org]

  […] patients with these conditions experience other forms of autonomic dysfunction, including erectile dys-function, neurogenic bladder, and constipation.11 NOH can also be caused by peripheral neuropathies, such as diabetic neuropathy, amyloidosis, and Guillain-Barré [ajmc.com]

• Altered Mental Status

  Have severely altered mental status. Have possible spinal injuries. Have lower extremity or pelvic fractures. Are not mobile enough to get out of bed. [ahrq.gov]

  Side effects include sedation, dry mouth, altered mental status, and excessive hypertension. 39 Pyridostigmine, an acetylcholinesterase inhibitor, may be utilized for the treatment of orthostatic hypotension. [uspharmacist.com]

The diagnosis of orthostatic hypotension is accurate, once blood pressure is measured in a patient who has been in a supine position for minimum 3 minutes, after standing up, as well as 3 and 5 minutes after they stand up. The last measurement is used to detect the extent to which blood pressure may drop upon standing but is not necessary for a decisive diagnosis [7]. Further tests are required in order to unveil the cause of the condition.

A detailed medical history is necessary, including symptoms elicited by OH, medications that the patient is taking and autonomic failure indications, such as severe constipation, incontinence, irregular sweating or tingling sensation of the feet. Physical examination may reveal dry skin and a neurological evaluation should be carried out to look for anything suggestive of Parkinson's disease.

Blood laboratory testing includes a complete blood count, ΗbA1c to diagnose diabetes, serum and urine protein electrophoresis, vitamin B12 and ANA autoantibodies. Plasma catecholamines are also measured, both in a standing and supine position; the measurement needs to take place when the patient is relaxed in a supine position and when they have stood up for at least 5 minutes.

A 24-hour urine sodium level can aid in treatment. [aafp.org]

Paraneoplastic neuropathies associated with leukemia are rare, and early diagnosis and treatment are crucial due to the potential for irreversible neurological deficits and delay in treatment of the leukemia. [ncbi.nlm.nih.gov]

Treatment of postural hypotension. J Neurol Neurosurg Psychiat 1998; 65: 285-9. 9 Oldenburg O, Kribben A, Baumgart D, Philipp T, Erbel R, Cohen MV. Treatment of orthostatic hypotension. [escardio.org]

Caffeine has been studied more extensively for the treatment of postprandial hypotension. [consultant360.com]

Prognosis The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition. x Prognosis The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition. [ninds.nih.gov]

During the follow-up period, 22 patients (34.4%) had a poor prognosis, of which 8 (36.4%) had OH, which tended to be higher than those with a favorable prognosis. [ncbi.nlm.nih.gov]

Prognosis The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition. [brainfacts.org]

The Merck Manual A look at the cardiac causes, symptoms, signs, diagnoses, prognosis and treatment of orthostatic hypotension and syncope. [curlie.org]

FOLLOW UP: If a reversible etiology is identified, orthostatic blood pressure and pulse should be repeated once the etiology is corrected to assure improvement and that multiple etiologies were not contributing factors. [consultgeri.org]

View/Print Table TABLE 2 Clinical Clues to Non-Neurogenic Etiologies of Orthostatic Hypotension Findings on history and physical examination Possible etiology Chest pain, palpations, shortness of breath, rales, edema, arrhythmia, murmur Congestive heart [aafp.org]

This is the first report showing that midodrine has the potential to improve post-spaceflight orthostatic hypotension and suggesting that reduced venous return contributes to the etiology. [ncbi.nlm.nih.gov]

This review alerts clinicians and clinician scientists to a common, yet often neglected, condition that occurs only upon an active change of posture and discusses its epidemiology, pathophysiology and management. [ncbi.nlm.nih.gov]

This review alerts clinicians and clinician scientists to a common, yet often neglected, condition that occurs only upon an active change of posture and discusses its epidemiology, pathophysiology and management. blood pressure dizziness initial orthostatic [doi.org]

Community-based epidemiological studies have demonstrated a high morbidity and mortality associated with neurogenic orthostatic hypotension. [neuroupdate.com.br]

The pathophysiology of IOH is thought to be a temporal mismatch between cardiac output and vascular resistance. [ncbi.nlm.nih.gov]

Both effects serve to increase blood pressure and maintain normal cerebral perfusion upon assuming the upright posture. 3 Pathophysiology Pathophysiology of orthostatic hypotension OH is defined as a reduction in systolic blood pressure by at least 20 [innovationsincrm.com]

To stabilize hemodynamics and prevent presyncope symptoms in these patients, noninvasive management is preferable. [ncbi.nlm.nih.gov]

The drug pyridostigmine is often quite helpful in preventing supine OH without worsening SH. In some SH/OH patients the swings in blood pressure are so extreme that midodrine or droxidopa is administered when upright to prevent OH. [innovationsincrm.com]

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7. Goldstein DS. Dysautonomia in parkinson disease. Compr Physiol. 2014 Apr;4(2):805–26.