ORTHOSTATIC HYPOTENSION IN PATIENTS WITH AUTONOMIC DYSFUNCTION IS KNOWN AS nOH

In patients with neurogenic orthostatic hypotension (nOH), the autonomic nervous system is dysfunctional. As a result, there is insufficient release of norepinephrine upon standing or following postural change, often because of a pre-existing neurodegenerative disorder.1-4

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PATIENTS MAY REVEAL SYMPTOMS WHEN ASKED SPECIFIC SCREENING QUESTIONS

Some patients experiencing symptoms of nOH may incorrectly attribute the symptoms to their pre-existing neurodegenerative disorder.Screening questions may help identify nOH in symptomatic patients.5-7

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PATIENTS WITH NEURODEGENERATIVE DISORDERS MAY BE AT RISK FOR SYMPTOMS OF nOH

Many patients with Parkinson’s disease, multiple system atrophy, pure autonomic failure, and autonomic neuropathies have nOH.1,8-10 Some patients may experience symptoms of nOH before their pre-existing neurologic condition becomes symptomatic.11-13 

 

References: 1. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 2. 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. 3. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 4. 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. 5. 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. 6. 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. 7. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458. 8. Ha AD, Brown CH, York MK, et al. The prevalence of symptomatic orthostatic hypotension in patients with Parkinson’s disease and atypical parkinsonism. Parkinsonism Relat Disord. 2011;17(8):625-628. 9. Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res. 1996;6(2):125-126. 10. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 11. Kalia LV, Lang AE. Parkinson’s disease. Lancet. 2015;386(9996):896-912. 12. Goldstein DS. Orthostatic hypotension as an early finding in Parkinson’s disease. Clin Auton Res. 2006;16(1):46-54. 13. Yabe I, Soma H, Takei A, et al. MSA-C is the predominant clinical phenotype of MSA in Japan: analysis of 142 patients with probable MSA. J Neurol Sci. 2006;249(2):115-121.