PATIENTS LIVING WITH nOH MAY EXPERIENCE CHALLENGES

Patients with nOH can become symptomatic at any time of the day and symptoms may vary from day to day, making certain activities of daily living challenging.2,5,6

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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.2,3,5,7

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CONSIDERATIONS FOR DIAGNOSING nOH

Orthostatic measurements, at-home blood pressure monitoring, excluding other causes, and specialty tests may help identify nOH in patients.1,2,5,8-12

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CONSIDER FOCUSING MANAGEMENT ON REDUCTION OF SYMPTOMS ASSOCIATED WITH nOH

Patients with nOH have a dysfunctional autonomic nervous system.2,5,7 Consider management options that aim to reduce symptoms of nOH rather than attempting to normalize blood pressure.2,8,10

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PATIENTS MAY EXPERIENCE nOH AND ASSOCIATED SUPINE HYPERTENSION

Up to 70% of patients with nOH have been shown to experience supine hypertension, which may present a clinical dilemma.2,13 There are some lifestyle adjustments a patient can make that may help manage the risks of associated supine hypertension.2,14

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References: 1. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 2. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 3. 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. 4. Maule S, Milazzo V, Maule MM, et al. Mortality and prognosis in patients with neurogenic orthostatic hypotension. Funct Neurol. 2012;27(2):101-106. 5. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 6. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458. 7. Isaacson SH, Skettini J. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa. Vasc Health Risk Manag. 2014;10:169-176. 8. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324. 9. Centers for Disease Control and Prevention. Measuring orthostatic blood pressure. www.cdc.gov/steadi/pdf/measuring_orthostatic_blood_pressure-a.pdf. Accessed December 18, 2017. 10. 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. 11. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139-146. 12. Stuebner E, Vichayanrat E, Low DA, et al. Twenty-four hour non-invasive ambulatory blood pressure and heart rate monitoring in Parkinson’s disease. Front Neurol. 2013;4:49. 13. 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(7):1752-1756. 14. Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens. 2002;4(2):139-145.