PRIORITIZE nOH SYMPTOM RELIEF IN DIAGNOSED PATIENTS

When patients are diagnosed with neurogenic orthostatic hypotension (nOH), management should focus on symptom relief. Due to the high degree of hemodynamic variability among nOH patients, restoring normal blood pressure may not be a realistic goal.1,2

The goals of nOH management are to improve physical functioning and alleviate the burden of symptoms, which may reduce consequences such as falls and fall-related injuries. Consider management methods that work to reduce symptoms of nOH, including lifestyle adjustments.2 Identifying orthostatic stressors can decrease the symptoms of nOH.1,2

ADJUSTMENTS IN A PATIENT’S DAILY ROUTINE MAY HELP RELIEVE nOH SYMPTOMS

For patients feeling dizzy, experiencing syncope, or having other symptoms that occur on standing and improve upon sitting, consider the following lifestyle adjustments1,3:

Dietary changes
  • Drinking a minimum of 2 L of water daily
  • Increasing salt intake
  • Eating smaller and more frequent meals, low in carbohydrates
Physical modifications
  • Exercising in the recumbent position (eg, stationary bicycle, rowing machine) 
  • Avoiding increased core body temperature 
  • Elevating head of bed 6 to 9 inches 
  • Wearing compression stockings or abdominal binder
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Exercise can help prevent deconditioning in patients with nOH. Because of the risk for falls due to nOH symptoms, patients should engage in recumbent or aquatic exercises. Strenuous upright activities, such as treadmill walking or running, are not recommended.1,2,4,5

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. Isaacson SH. Managed care approach to the treatment of neurogenic orthostatic hypotension. Am J Manag Care. 2015;21(suppl 13):s258-s268. 
  3. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624.
  4. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.  
  5. Rascol O, Perez-Lloret S, Damier P, et al. Falls in ambulatory non-demented patients with Parkinson's disease. J Neural Transm. 2015;122:1447-1455.