Diagnosing and treating neurogenic orthostatic hypotension in primary care

摘要: In response to a change in posture from supine or sitting standing, autonomic reflexes normally maintain blood pressure (BP) by selective increases arteriovenous resistance and increased cardiac output, ensuring continued perfusion of the central nervous system. neurogenic orthostatic hypotension (NOH), inadequate vasoconstriction output cause BP drop excessively, resulting perfusion, with predictable symptoms such as dizziness, lightheadedness falls. The condition may represent failure baroreceptor signals modulate cardiovascular function, peripheral norepinephrine release sympathetic nerve endings, both. Symptomatic patients benefit both non-pharmacologic pharmacologic interventions. Among latter, two pressor agents have been approved US Food Drug Administration: sympathomimetic prodrug midodrine, 1996 for symptomatic hypotension, droxidopa, 2014, which is indicated treatment caused primary (Parkinson's disease, multiple system atrophy pure failure). A wide variety off-label options also described (e.g. synthetic mineralocorticoid fludrocortisone). Because promote hypertension, NOH management requires monitoring lifestyle measures minimize head-of-bed elevation). However, has associated cognitive impairment patient's risk syncope falls, potential serious consequences. Hence, concerns about hypertension - long-term prognosis yet be established must sometimes balanced need address immediate risks.