CARDINAL SYMPTOMS OF nOH INCLUDE DIZZINESS AND LIGHTHEADEDNESS1-4

Other symptoms associated with neurogenic orthostatic hypotension (nOH) include generalized weakness, blurred vision, cognitive slowing, and coat-hanger pain.1,4

Additional Symptoms

A SUDDEN DROP IN BLOOD PRESSURE FOLLOWING POSTURAL CHANGE MAY RESULT IN SYMPTOMATIC EPISODES

Symptomatic episodes may not immediately follow postural change. In a study of nOH patients, 50% developed symptoms within a minute of standing, and 75% developed symptoms within 5 minutes of standing.4 Patients may vary by what level of blood pressure drop causes symptomatic episodes.3,5,6 Symptoms typically improve when patients with nOH sit or lie down and adequate blood flow to the brain resumes.2,3 The accuracy of in-clinic orthostatic measurements may be affected by the delay in symptoms following a postural change. To help facilitate the diagnosis process, it may be useful for such patients to conduct and record blood pressure measurements at home.3,6-9

TIME OF DAY, DIET, AND TEMPERATURE MAY AFFECT THE SEVERITY OF SYMPTOMS

Certain factors may worsen a patient’s nOH symptoms. Although a patient may become symptomatic at any time of the day, the early morning may be worse because of nocturnal diuresis.1,3,5 Patients may feel symptomatic within 30 minutes of eating a meal because of associated postprandial splanchnic vasodilation. Temperature also has been linked to symptom severity, as increased core temperature, such as in a hot bath, can lead to peripheral vasodilation.3,5,10

nOH SYMPTOMS MAY RESULT IN SERIOUS CONSEQUENCES

Symptoms associated with nOH may be difficult for patients to manage on their own because symptomatic episodes may occur at any time of the day.3,5,7 Feeling suddenly dizzy or lightheaded while conducting activities of daily living could put patients at risk for serious consequences.1-3,7,11,12 As a result, some patients may withdraw from their daily lives and resort to physical inactivity.1,3,7

SCREENING QUESTIONS MAY HELP IDENTIFY nOH IN SYMPTOMATIC PATIENTS

Patients living with nOH may dismiss their nOH symptoms as being associated with their pre-existing neurodegenerative disorder.7 Screening questions may help distinguish between nOH symptoms and symptoms of a patient's pre-existing neurodegenerative disorder.2,5,8

CONSIDER THESE SCREENING QUESTIONS2,5,8:

  • Do you feel dizzy or lightheaded upon standing?
  • Are the symptoms worse in the morning or after meals?
  • Have you fainted/blacked out recently?
  • Do the symptoms improve or disappear when you sit or lay down?

References: 1. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 2. 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. 3. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 4. 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. 5. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458. 6. 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. 7. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 8. 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. 9. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324. 10. Mathias CJ. Autonomic diseases: clinical features and laboratory evaluation. J Neurol Neurosurg Psychiatry. 2003;74(suppl 3):iii31-iii41. 11. 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. 12. Maule S, Milazzo V, Maule MM, et al. Mortality and prognosis in patients with neurogenic orthostatic hypotension. Funct Neurol. 2012;27(2):101-106.