Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem

Author:

Fedorowski Artur12ORCID,Ricci Fabrizio134ORCID,Hamrefors Viktor15ORCID,Sandau Kristin E.6ORCID,Hwan Chung Tae7,Muldowney James A.S.8ORCID,Gopinathannair Rakesh9ORCID,Olshansky Brian10ORCID

Affiliation:

1. Department of Clinical Sciences, Lund University, Malmö (A.F., F.R., V.H.).

2. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (A.F.).

3. Department of Neuroscience, Imaging & Clinical Sciences, “G.d’Annunzio” University, Chieti-Pescara (F.R.).

4. Casa di Cura Villa Serena, Città Sant’Angelo, Italy (F.R.).

5. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (V.H.).

6. Department of Nursing, Bethel University, St. Paul, MN (K.E.S.).

7. Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD (T.H.C.).

8. Vanderbilt University Medical Center, Nashville, TN (J.A.S.M.).

9. Kansas City Heart Rhythm Institute, Overland Park, KS (R.G.).

10. University of Iowa, Iowa City (B.O.).

Abstract

Orthostatic hypotension (OH), a common, often overlooked, disorder with many causes, is associated with debilitating symptoms, falls, syncope, cognitive impairment, and risk of death. Chronic OH, a cardinal sign of autonomic dysfunction, increases with advancing age and is commonly associated with neurodegenerative and autoimmune diseases, diabetes, hypertension, heart failure, and kidney failure. Management typically involves a multidisciplinary, patient-centered, approach to arrive at an appropriate underlying diagnosis that is causing OH, treating accompanying conditions, and providing individually tailored pharmacological and nonpharmacological treatment. We propose a novel streamlined pathophysiological classification of OH; review the relationship between the cardiovascular disease continuum and OH; discuss OH-mediated end-organ damage; provide diagnostic and therapeutic algorithms to guide clinical decision making and patient care; identify current gaps in knowledge and try to define future research directions. Using a case-based learning approach, specific clinical scenarios are presented highlighting various presentations of OH to provide a practical guide to evaluate and manage patients who have OH.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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