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EFNS guidelines on the diagnosis and management of orthostatic hypotension
Open accessAbstract
Orthostatic (postural) hypotension (OH) is a common, yet under diagnosed disorder. It may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in primary and secondary autonomic disorders. These range from visual disturbances and dizziness to loss of consciousness (syncope) after postural change. Evidence based guidelines for the diagnostic workup and the therapeutic management (non‐pharmacological and pharmacological) are provided based on the EFNS guidance regulations. The final literature research was performed in March 2005. For diagnosis of OH, a structured history taking and measurement of blood pressure (BP) and heart rate in supine and upright position are necessary. OH is defined as fall in systolic BP below 20 mmHg and diastolic BP below 10 mmHg of baseline within 3 min in upright position. Passive head‐up tilt testing is recommended if the active standing test is negative, especially if the history is suggestive of OH, or in patients with motor impairment. The management initially consists of education, advice and training on various factors that influence blood pressure. Increased water and salt ingestion effectively improves OH. Physical measures include leg crossing, squatting, elastic abdominal binders and stockings, and careful exercise. Fludrocortisone is a valuable starter drug. Second line drugs include sympathomimetics, such as midodrine, ephedrine, or dihydroxyphenylserine. Supine hypertension has to be considered.
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“Initially, it is also agreed to start with non-pharmacological measures (Lahrmann et al., 2006), because of the lower likelihood of adverse outcomes, the possibility of using them in moments of orthostatic stress (Low and Singer, 2008) and for their simplicity (Seppi et al.”
BackgroundInfluentialFedorowski, A., Stavenow, L., Hedblad, B., Berglund, G. L., Nilsson, P. M., & Melander, O. (2010) · Journal of Hypertension · doi:10.1097/hjh.0b013e3283350e8c · Cited by 57
Reverse blood pressure dipping as marker of dysautonomia in Parkinson disease
Milazzo, V., Stefano, C. D., Vallelonga, F., Sobrero, G., Zibetti, M., Romagnolo, A., Merola, A., Milan, A., Espay, A. J., Lopiano, L., et al. (2018) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2018.06.032 · Cited by 56
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Current Concepts in Orthostatic Hypotension Management
Arnold, A. C., & Shibao, C. A. (2013) · Current Hypertension Reports · doi:10.1007/s11906-013-0362-3 · Cited by 56
“In patients unable to tolerate standing or in those with suspicion of OH despite normal vital signs, head-up tilt table testing to an angle at least 60 ° should be considered [40].”
BackgroundEffect of Parasympathetic Stimulation on Brain Activity During Appraisal of Fearful Expressions
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“Ten-minute orthostatic vital signs may show a heart rate increase greater than 30 beats per minute (bpm) after standing (or in those aged 12–19 year, more than 40 bpm).(75) Patients with cognitive complaints may benefit from a thorough neurologic examination to identify focal neurologic deficits.”
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“The 2006 and 2011 European Federation of Neurological Society guidelines provide recommendations that will be discussed throughout this review.32,33 In 2013, the American Society of Hypertension released a position paper regarding the treatment of OH.6 Table 3 provides a summary of the literature discussed for each ag…”
BackgroundMethodInfluentialOrthostatic hypotension in Parkinson disease: Impact on health care utilization
Merola, A., Sawyer, R. P., Artusi, C. A., Suri, R., Berndt, Z., Lopez‐Castellanos, J. R., Vaughan, J. E., Vizcarra, J. A., Romagnolo, A., & Espay, A. J. (2017) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2017.11.344 · Cited by 49
A new integrated instrumental approach to autonomic nervous system assessment
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“In order to understand and analyse the beat-to-beat changes in BP and HR induced by the manoeuvres and to check the correctness of the procedure, ECG and pressures waves must be acquired in real time [9] with instrumentation such as the Finometer (FMS, Amsterdam, The Netherlands) or Nexfin System (Edwards Lifesciences…”
MethodSelf-citationA systematic review of the pharmacological management of orthostatic hypotension
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Device-Guided Breathing as Treatment for Hypertension in Type 2 Diabetes Mellitus
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Autonomic Dysfunction in Patients with Mild to Moderate Alzheimer’s Disease
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“Existing clinical guidelines advocate for the preliminary assessment of orthostatic hypotension prior to the commencement or escalation of antihypertensive regimens, in addition to ongoing surveillance of medication safety throughout the therapeutic course [38].”
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Orthostatic Hypotension Does Not Increase Cardiovascular Risk in the Elderly at a Population Level
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Metadata
- Authors
- Lahrmann, H., Cortelli, P., Hilz, M., Mathias, C. J., Struhal, W., & Tassinari, M.
- Affiliations
- Kaiser-Franz-Josef-Spital (AT)
- University of Bologna (IT)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- St Mary's Hospital (GB)
- Corresponding author
- Lahrmann, H.
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2006-08-23
- Volume
- 13
- Issue
- 9
- Pages
- 930-936
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W1983067632
- Cited by
- 334
- References
- 56
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 13 · 2023: 19 · 2022: 22 · 2021: 19 · 2020: 13 · 2019: 26 · 2018: 18 · 2017: 23 · 2016: 23 · 2015: 11 · 2014: 23 · 2013: 19 · 2012: 21
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- orthostatic hypotension, autonomic dysfunction, syncope, head-up tilt, blood pressure measurement, fludrocortisone, midodrine, sympathomimetic drugs, non-pharmacological treatment, supine hypertension
- MeSH terms
- Diagnosis, Differential, Humans, Hypotension, Orthostatic, Practice Guidelines as Topic
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