SPECIALTY TESTS MAY HELP IDENTIFY nOH IN SYMPTOMATIC PATIENTS

If a patient is symptomatic but in-office orthostatic blood pressure tests do not indicate neurogenic orthostatic hypotension (nOH), consider the following tests:

 

24-HOUR AMBULATORY BLOOD PRESSURE MONITORING

Patient annotates the times during which he or she is supine or standing. This test may be able to aid in understanding a patient’s fluctuation of blood pressure ranges.1-3

AUTONOMIC FUNCTION TESTS1-5

  • Quantitative sudomotor axon reflex test
  • Thermoregulatory sweat test
  • Valsalva ratio
  • Tilt-table test

 

CONSIDER CONSULTING A SPECIALIZED AUTONOMIC DISORDER CENTER TO HELP YOUR PATIENTS

An autonomic disorder specialist may be able to help identify or confirm nOH in symptomatic patients. This specialist may be able to conduct additional specialty tests to diagnose nOH in symptomatic patients. Among these are autonomic reflex testing, plasma fractionated catecholamine levels, and/or sudomotor function testing.1,4,5

References: 1. 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. 2. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 3. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324. 4. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 5. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.