IN-CLINIC ORTHOSTATIC MEASUREMENTS MAY HELP IDENTIFY nOH IN PATIENTS

If a patient is experiencing symptoms associated with neurogenic orthostatic hypotension (nOH), it may be useful to monitor his or her blood pressure and heart rate changes while standing and supine.^1-3 It is important to note that not all patients experience nOH symptoms immediately following a postural change. Patients may need assistance while orthostatic measurements are being taken, as a symptomatic episode may occur immediately or a few minutes after standing.^1,4,5

Recommendations from the Centers for Disease Control and Prevention include the following³:

1. Have the patient lie down for 5 minutes.

2. Measure the patient's blood presure and pulse rate.

4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes.

Healthy, normally volume-replete individuals will typically experience a systolic blood pressure drop of <10 mm Hg, an approximate increase of 2.5 mm Hg in diastolic blood pressure, and a 10-20 bpm increase in heart rate.^2,4,6,7 These postural adjustments to blood pressure are initiated by adequate release of norepinephrine.⁸Any heart rate changes greater than 15 bpm within 3 minutes of standing suggests non-neurogenic orthostatic hypotension. If a symptomatic patient’s heart rate changes less than 15 bpm within 3 minutes of standing, he or she may have nOH.^1,2,4,6,8

At-home monitoring

Managing nOH symptoms

References: 1. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324. 2. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 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, Opfer-Gehrking TL, McPhee BR, et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995;70(7):617-622. 6. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 7. Naschitz JE, Rosner I. Orthostatic hypotension: framework of the syndrome. Postgrad Med J. 2007;83(983):568-574. 8. 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.