81% of multiple system atrophy patients have symptoms of nOH

A MAJORITY OF PATIENTS WITH MULTIPLE SYSTEM ATROPHY ALSO HAVE SYMPTOMS ASSOCIATED WITH nOH

Symptoms of neurogenic orthostatic hypotension (nOH) affect 81% of patients with multiple system atrophy.1 nOH is considered a hallmark sign of multiple system atrophy, also known as Shy-Drager syndrome.2-5

MULTIPLE SYSTEM ATROPHY IS A NEURODEGENERATIVE DISORDER THAT CAN DAMAGE A PATIENT’S AUTONOMIC NERVOUS SYSTEM

Multiple system atrophy is an adult-onset, progressive neurodegenerative disorder that is characterized by parkinsonian features, cerebellar ataxia, and autonomic failure that can vary in severity.5,6 As a neurodegenerative disorder, multiple system atrophy may affect a patient’s autonomic nervous system.7-9 The autonomic nervous system may not be able to release sufficient levels of norepinephrine in response to postural change. Norepinephrine is the major neurotransmitter responsible for blood pressure maintenance and such a deficiency may cause patients to experience symptoms of nOH.3,7,9,10 If your patients with multiple system atrophy are experiencing dizziness, lightheadedness, or other symptoms that improve upon sitting, they could have nOH.4,7,9

 

PATIENTS WITH MULTIPLE SYSTEM ATROPHY AND nOH MAY ALSO EXPERIENCE SUPINE HYPERTENSION

Patients with multiple system atrophy lack the normal blood pressure buffering mechanisms that offset both hypo- and hypertension.11-13 This means that most multiple system atrophy patients diagnosed with nOH will likely also experience supine hypertension.12,14 Supine hypertension may occur at any point during the day when a patient is in a recumbent position.2,15 Certain daily adjustments may help a patient manage his or her supine hypertension.2,7 

References: 1. 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. 2. Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens. 2002;4(2):139-145. 3. 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. 4. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 5. Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71(9):670-676. 6. Flabeau O, Meissner WG, Tison F, et al. Multiple system atrophy: current and future approaches to management. Ther Adv Neurol Disord. 2010;3(4):249-263. 7. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 8. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139-146. 9. 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. 10. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 11. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458. 12. 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. 13. Naschitz JE, Slobodin G, Elias N, et al. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J. 2006;82(966):246-253. 14. Goldstein DS, Pechnik S, Holmes C, et al. Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension. 2003;42(2):136-142. 15. 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.