CARDINAL SYMPTOMS OF nOH INCLUDE DIZZINESS AND LIGHTHEADEDNESS1-3

Feeling suddenly dizzy or lightheaded while conducting activities of daily living could put patients at risk for serious consequences, such as falling.4-6

Additional Symptoms of nOH List

ADDITIONAL SYMPTOMS ASSOCIATED WITH NEUROGENIC ORTHOSTATIC HYPOTENSION (nOH) 1,3 :

  • Syncope
  • Generalized weakness
  • Fatigue
  • Blurred vision
  • Cognitive slowing
  • Coat-hanger (neck and shoulder) pain
  • Orthostatic dyspnea
  • Orthostatic angina

 

A SUSTAINED 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 standing3
  • The level of blood pressure changes that lead to symptoms may vary from patient to patient7
  •  Symptoms typically improve when patients with nOH sit or lie down and adequate blood flow to the brain resumes2,8
  • 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 certain patients to conduct and record blood pressure measurements at home4,9,10
Diet, Time, and Temperature Icon

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

Although a patient may become symptomatic at any time of the day, the early morning may be the worst due to nocturnal diuresis.1,7 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.7,11

nOH SYMPTOMS MAY RESULT IN SERIOUS CONSEQUENCES, INCLUDING FALLS

“I stood up and just about couldn’t stand. I had to grab something to hold on or else I felt like I was going to fall over.”—Leo, patient with symptomatic nOH

  • Symptoms associated with nOH may be difficult for patients to manage on their own because symptomatic episodes can occur at any time of the day4,7
  • Patients with nOH may restrict their activities due to a fear of sudden symptomatic episodes and falls upon postural change4,8,9
  • As a result, some patients may withdraw from their daily lives and resort to physical inactivity4,8
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. 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.
  4. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.
  5. 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.
  6. 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.
  7. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458.
  8. Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract. 2017;4(3):298-308.
  9. 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.
  10. Shibao C, Lipsitz LA, Biaggioni I. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013;7(4):317-324.
  11. Mathias CJ. Autonomic diseases: clinical features and laboratory evaluation. J Neurol Neurosurg Psychiatry. 2003;74(suppl 3):iii31-iii41.