I’M AFRAID TO FAINT AGAIN

If your patients are suffering from dizziness, lightheadedness, or other symptoms that improve upon sitting, they could have neurogenic orthostatic hypotension (nOH).^1-3nOH and its associated symptoms may increase the risk of falling and lead to serious consequences.^2,4,5

Patients living with nOH may experience varying symptoms at any time of the day, making it difficult to complete certain activities of daily living.^3,4

nOH CAN OCCUR WHEN THE NEUROLOGIC FUNCTIONS THAT REGULATE BLOOD PRESSURE ARE DISRUPTED

A patient may suffer from symptoms of nOH if he or she has a neurodegenerative disorder that disrupts the autonomic nervous system's ability to release norepinephrine.^2,4

DIAGNOSTICS CONSIDERATIONS

Orthostatic measurements, at-home blood pressure monitoring, excluding other causes, and specialty tests may help identify patients with nOH.^1,4,6

CONSIDER FOCUSING ON REDUCTION OF SYMPTOMS

Patients with nOH have a dysfunctional autonomic nervous system.^1,4 Rather than attempting to normalize blood pressure, consider management options that aim to reduce symptoms associated with nOH.^6,7

MANY PATIENTS WITH nOH ALSO EXPERIENCE SUPINE HYPERTENSION

Up to 70% of patients with nOH experience supine hypertension.⁸ Certain lifestyle adjustments may help manage the risks of associated supine hypertension.^1,6

Identifying Neurogenic Orthostatic Hypotension Video

Listen as Dr Daniel Claassen, movement disorders specialist,

discusses his approach to diagnosing nOH

REFERENCES

Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358:615-624.
Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.
Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract. 2017;4(3):298-308.
Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.
Rascol O, Perez-Lloret S, Damier P, et al. Falls in ambulatory non-demented patients with Parkinson's disease. J Neural Transm (Vienna). 2015;122(10):1447-1455.
Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567-1582.
Isaacson SH. Managed care approach to the treatment of neurogenic orthostatic hypotension. Am J Manag Care. 2015;21(suppl 13):s258-s268.
Berganzo K, Diez-Arrola B, Tijero B, et al. Nocturnal hypertension and dysautonomia in patients with Parkinson's disease: are they related? J Neurol. 2013;260:1752-1756.