nOH DIAGNOSTIC CONSIDERATIONS

In-Clinic Monitoring >> Orthostatic measurements taken after supine for a few minutes and again after standing for a few minutes may help identify neurogenic orthostatic hypotension (nOH) in patients.1-3

At-Home Monitoring >> Orthostatic measurements may also be taken at home by the patient to help identify nOH in patients with delayed symptomatic episodes.2,4-6

Excluding Other Causes >> There may be other causes for unexplained symptomatic episodes besides nOH.2,4,7

Specialty Testing >> Specialty tests for diagnosing nOH include, but are not limited to, 24-hour ambulatory blood pressure monitoring and the tilt table test.4,5,8

SCREENING QUESTIONS MAY BE USEFUL IN IDENTIFYING PATIENTS EXPERIENCING SYMPTOMS OF nOH

Some patients with nOH may mistake their nOH symptoms as being associated with their pre-existing neurodegenerative disorder.5 Screening questions may help identify nOH in patients experiencing symptoms upon standing.4,9,10

References: 1. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 2. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324. 3. 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. 4. 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. 5. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 6. 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. 7. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139-146. 8. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 9. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458. 10. Kaufmann H, Malamut R, Norcliffe-Kaufmann L, et al. The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res. 2012;22(2):79-90.