Preventing and Treating Orthostatic Hypotension: As Easy As A, B, C
REE VI W CME EDUCATIONAL OBJECTIVE: Readers will teach their patients to avoid episodes of orthostatic hypotension CREDIT JUAN J. FIGUEROA, MD JEF F REY R. BASFORD, MD, PhD PHILLI P A. LOW, MD Department of Neurology, Mayo Department of Physical Medicine and Rehabili- Department of Neurology, Mayo Clinic, Clinic, Rochester, MN tation, Mayo Clinic, Rochester, MN Rochester, MN Preventing and treating orthostatic hypotension: As easy as A, B, C ■ ABSTRT AC rthostatic hypotension is a chronic, O debilitating illness associated with com- Orthostatic hypotension is a chronic, debilitating illness mon neurologic conditions (eg, diabetic neu- that is difficult to treat. The therapeutic goal is to im- ropathy, Parkinson disease). It is common in prove postural symptoms, standing time, and function the elderly, especially in those who are institu- rather than to achieve upright normotension, which can tionalized and are using multiple medications. lead to supine hypertension. Drug therapy alone is never Treatment can be challenging, especially if the problem is neurogenic. This condition adequate. Because orthostatic stress varies with circum- has no cure, symptoms vary in different cir- stances during the day, a patient-oriented approach that cumstances, treatment is nonspecific, and ag- emphasizes education and nonpharmacologic strategies gressive treatment can lead to marked supine is critical. We provide easy-to-remember management hypertension. recommendations, using a combination of drug and non- This review focuses on the prevention and drug treatments that have proven efficacious. treatment of neurogenic causes of orthostatic hypotension. We emphasize a simple but ef- ■ KEY POINTS fective patient-oriented approach to manage- ment, using a combination of nonpharmaco- Treatment is directed at increasing blood volume, de- logic strategies and drugs clinically proven creasing venous pooling, and increasing vasoconstriction to be efficacious.
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