Perspectives on the Treatment of Orthostatic Hypotension Associated With Hypertension
Article Outline
Orthostatic hypotension is defined as a reduction in systolic blood pressure of at least 20 mmHg or a reduction in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing up. The frequent and rapid cardiovascular adjustments essential for homeostatic control of blood pressure are not accomplished in patients with orthostatic hypotension, who experience symptomatic and often extreme high and low blood pressure variations. In most cases, the underlying cause of orthostatic hypotension is not amenable to correction, and patients have lifelong symptoms. Current treatment strategies are directed at improving patients' symptoms by raising blood pressure. Such interventions, however, do not address the coincident problems of extreme high blood pressure, nocturnal hypertension, and resultant end-organ damage present in these patients.
Key words: hypertension , orthostatic hypotension
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References
- The definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy . J Auton Nerv Syst . 1996;58:123–124
- . Characteristics of 100 consecutive patients presenting with orthostatic hypotension . Mayo Clin Proc . 2004;79:890–894
- . Orthostatic hypotension: causes, mechanisms, and influencing factors . Neurology . 1995;45(4 Suppl 5):S6–11
- . Treatment of orthostatic disorders and baroreflex failures. . In: Izzo JL , Black HR editor. Hypertension Primer . 3rd edition. Philadelphia: Lippincott Williams & Wilkins; 2003;p. 479–482
- . Thalamic hemorrhage following carotid endarterectomy-induced labile blood pressure: controlling the liability with clonidine - a case report . Angiology . 1999;50:327–330
- . Hypertensive cardiovascular damage in patients with primary autonomic failure . Lancet . 2000;355:725–726
- . Physical manoeuvres for combating orthostatic dizziness in autonomic failure . Lancet . 1992;339:897–898
- . Postprandial hypotension: epidemiology, pathophysiology, and clinical management . Ann Intern Med . 1995;122:286–295
- . A potent pressor response elicited by drinking water . Lancet . 1999;353:723
- . Haemodynamic responses during head-up tilt and tilt reversal in two groups with chronic autonomic failure: pure autonomic failure and multiple system atrophy . J Neurol . 2002;249:542–548
- . Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope . Clin Auton Res . 1998;8:231–235
- . Haemodynamic analysis of efficacy of compression hosiery in elderly fallers with orthostatic hypotension . Lancet . 1999;354:45–46
- Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine . Am J Med . 1993;95:38–48
- Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial . JAMA . 2001;285:52–59
- . Acute pulmonary edema and compression garments . Mayo Clin Proc . 1999;74:946
PII: S1561-5413(09)60181-2
doi:10.1016/S1561-5413(09)60181-2
© 2005 The Hong Kong Society of Nephrology. Published by Elsevier Inc. All rights reserved.
