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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Neurol
2015 ; 11
(3
): 220-6
Nephropedia Template TP
J Clin Neurol
2015[Jul]; 11
(3
): 220-6
PMID26174784
show ga
Orthostatic hypotension (OH) occurs when mechanisms for the regulation of
orthostatic BP control fails. Such regulation depends on the baroreflexes, normal
blood volume, and defenses against excessive venous pooling. OH is common in the
elderly and is associated with an increase in mortality rate. There are many
causes of OH. Aging coupled with diseases such as diabetes and Parkinson's
disease results in a prevalence of 10-30% in the elderly. These conditions cause
baroreflex failure with resulting combination of OH, supine hypertension, and
loss of diurnal variation of BP. The treatment of OH is imperfect since it is
impossible to normalize standing BP without generating excessive supine
hypertension. The practical goal is to improve standing BP so as to minimize
symptoms and to improve standing time in order to be able to undertake
orthostatic activities of daily living, without excessive supine hypertension. It
is possible to achieve these goals with a combination of fludrocortisone, a
pressor agent (midodrine or droxidopa), supplemented with procedures to improve
orthostatic defenses during periods of increased orthostatic stress. Such
procedures include water bolus treatment and physical countermaneuvers. We
provide a pragmatic guide on patient education and the patient-orientated
approach to the moment to moment management of OH.