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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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Association between orthostatic hypotension, mortality, and cardiovascular disease in Asians
Chou, R., Liu, C., Chao, T., Chen, S., Tuan, T., Chen, T., & Chen, S.-A. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.05.060 · Cited by 27
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“Orthostatic hypotension (OH), the sustained drop of blood pressure that occurs upon postural challenge, is traditionally defined as a blood pressure drop of at least 20 mmHg in systolic blood pressure (SBP) and/or 10 mmHg in diastolic blood pressure within 3 min of active standing or head-up tilt table (HUT) testing a…”
BackgroundApplication of the Sit-Up Test for orthostatic hypotension in individuals with stroke
Tang, A., Eng, J. J., & Krassioukov, A. V. (2012) · Autonomic Neuroscience · doi:10.1016/j.autneu.2012.02.002 · Cited by 24
“Guidelines recommend that resuscitation and cardiac life support procedures are in place prior to an orthostatic challenge test (Lahrmann et al., 2006).”
BackgroundDroxidopa for orthostatic hypotension
Strassheim, V., Newton, J. L., Tan, M. P., & Frith, J. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000001043 · Cited by 24
“Two studies mentioned salt and water intake, compression garments and sleeping with the head of the bed elevated, all of which feature in international recommendations but it is unclear how well participants adhered with these therapies [1,38].”
BackgroundChemical pharmacotherapy for the treatment of orthostatic hypotension
Cheshire, W. P. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1543404 · Cited by 24
“Among themedications available to treat nOH (see Figure 2), fludrocortisone and midodrine have long been considered firstline therapy [59,60], and droxidopa is the most recent drug to become available in the United States.”
BackgroundOrthostatic hypotension: definition, classification and evaluation
Tzur, I., Izhakian, S., & Gorelik, O. (2019) · Blood Pressure · doi:10.1080/08037051.2019.1604067 · Cited by 25
“that can cause or aggravate OH (Table 3) [1,16,42].”
BackgroundMethodInfluentialSymptomatic therapy of multiple system atrophy
Rohrer, G., Höglinger, G. U., & Levin, J. (2017) · Autonomic Neuroscience · doi:10.1016/j.autneu.2017.10.006 · Cited by 24
“Nonpharmacologic management should include elastic stockings and abdominal bands (Fanciulli et al., 2016), adequate intake of salt and fluid and avoiding exposure to hot, humid environments (Deguchi et al., 2007; Lahrmann et al., 2006).”
BackgroundEarly discontinuation of treatment in patients with orthostatic hypotension
Shibao, C. A., Grijalva, C. G., Lipsitz, L. A., Biaggioni, I., & Griffin, M. R. (2013) · Autonomic Neuroscience · doi:10.1016/j.autneu.2013.08.064 · Cited by 23
“The only available treatment guideline, from the European Federation of Neurological Societies (EFNS) (Lahrmann et al., 2006), recommends fludrocortisone, a synthetic aldosterone analog, as the primary therapy for OH.”
BackgroundTreatment options for non-motor symptoms in late-stage Parkinson's disease
Coelho, M. M., Ferreira, J. J., Rosa, M. M., & Sampaio, C. (2008) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.9.4.523 · Cited by 23
“Their use is best restricted to a dose in the early morning and early afternoon, when the symptoms are worst, taken 30 – 45 min before activity [8,56,81,82] .”
BackgroundInfluentialSun, J., Sang, H., Yang, C., Dong, H., Lei, C., Lu, Y., Ma, Y., Zhou, X., Sun, X., & Xiong, L. (2012) · EP Europace · doi:10.1093/europace/eus220 · Cited by 23
Li, L., Guo, P. F., Ding, D., Lian, T., Zuo, L., Du, F., & Zhang, W. (2019) · Neurological Research · doi:10.1080/01616412.2019.1610224 · Cited by 23
“for diastolic BP (DBP) from baseline within 3 min after moving into an upright position, if the patient’s SBP was not higher than 150 mmHg at baseline [3].”
BackgroundCompression therapy in patients with orthostatic hypotension: a systematic review.
Smeenk, H. E., Koster, M. J., Faaij, R. A., de Geer, D. B., & Hamaker, M. E. (2014) · PubMed · Cited by 23
Struhal, W., Javor, A., Brunner, C., Benesch, T., Schmidt, V., Vosko, M. R., & Ransmayr, G. (2014) · Journal of Alzheimer s Disease · doi:10.3233/jad-140531 · Cited by 22
“Adaptation of antihypertensive medication often improves OH in those patients [15, 23]. dysfunction is not autonomic testing but history taking [ History taking might be obstructed due to amnesia syncopal episodes in elderly patients [24].”
Self-citationTraon, A. P., Brefel‐Courbon, C., Dupouy, J., Ory‐Magne, F., Rascol, O., & Sénard, J. (2017) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2017.11.003 · Cited by 22
Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up
Hohtari-Kivimäki, U., Salminen, M. J., Vahlberg, T. J., & Kivelä, S. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.07.010 · Cited by 22
Treatment strategies for clozapine-induced hypotension: a systematic review
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“Our approach to treatment, incorporating expert consensus guidelines and opinions [2, 10, 55, 56], is summarised below:”
MethodVaidyanathan, S., Soni, B. M., & Hughes, P. L. (2007) · Advances in Therapy · doi:10.1007/bf02849965 · Cited by 21
Identification and management of orthostatic hypotension in older and medically complex patients
Mader, S. L. (2012) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.12.11 · Cited by 21
Scala, I., Bellavia, S., Luigetti, M., Brunetti, V., Broccolini, A., Gabrielli, M., Verme, L. Z. D., Calabresi, P., Marca, G. D., & Frisullo, G. (2022) · Neurological Sciences · doi:10.1007/s10072-022-06136-2 · Cited by 21
“All the subjects included in the study underwent to an active stand test [19].”
Orthostatic Circulatory Disorders: From Nosology to Nuts and Bolts
Gutkin, M. C., & Stewart, J. M. (2016) · American Journal of Hypertension · doi:10.1093/ajh/hpw023 · Cited by 20
Prediction of orthostatic hypotension in multiple system atrophy and Parkinson disease
Sun, Z., Jia, D., Shi, Y., Hou, X., Yang, X., Guo, J., Li, N., Wang, J., Sun, Q., Zhang, H., et al. (2016) · Scientific Reports · doi:10.1038/srep21649 · Cited by 20
“Patients were excluded from our analysis if they met the following criteria: (1) unable to stand for 3 minutes, or apparent instability of standing and/or limbs tremor; (2) a mode of inheritance; (3) less than 8 hours after the last oral medicines such as anti-parkinsonism, anti-depressive, anti-arrhythmic, and anti-h…”
MethodSheppard, J. P., Burt, J., Lown, M. T., Temple, E., Benson, J., Ford, G. A., Heneghan, C. J., Hobbs, R. F., Jowett, S. M., Little, P. S., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022930 · Cited by 23
“To test for orthostatic hypotension, two further readings will be taken in the standing position after 1 and 3 min.(25) Only the research facilitator/nurse will be present during the blood pressure measurements.”
BackgroundHeras‐Garvin, A., Refolo, V., Reindl, M., Wenning, G. K., & Stefanova, N. (2020) · Journal of Neuroinflammation · doi:10.1186/s12974-020-1714-y · Cited by 20
Orthostatic changes in blood pressure and mortality in a nursing home population
Hartog, L. C., Hendriks, S. H., Cimzar-Sweelssen, M., Knipscheer, A., Groenier, K. H., Kleefstra, N., Bilo, H. J. G., & van Hateren, K. J. J. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000910 · Cited by 20
“Orthostatic hypotension was defined as a drop in SBP of at least 20mmHg or DBP of at least 10mmHg after postural change compared with the mean value of the baseline measurements in supine position [3].”
MethodDiabetic Cardiac Autonomic Neuropathy
Serhiyenko, V. A., & Serhiyenko, A. A. (2023) · Springer eBooks · doi:10.1007/978-3-031-25519-9_57 · Cited by 26
Juraschek, S. P., Lipsitz, L. A., Beach, J. L., & Mukamal, K. J. (2019) · American Journal of Hypertension · doi:10.1093/ajh/hpz015 · Cited by 19
Diabetic Cardiac Autonomic Neuropathy
Serhiyenko, V. A., & Serhiyenko, A. A. (2019) · Springer eBooks · doi:10.1007/978-3-030-11815-0_53 · Cited by 18
Hartog, L. C., Cizmar-Sweelssen, M., Knipscheer, A., Groenier, K. H., Kleefstra, N., Bilo, H. J. G., & van Hateren, K. J. J. (2015) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2015.05.005 · Cited by 18
Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension
Sturchio, A., Dwivedi, A. K., Marsili, L., Hadley, A. J., Sobrero, G., Heldman, D. A., Maule, S. V., Lopiano, L., Comi, C., Versino, M., et al. (2020) · Journal of Neurology · doi:10.1007/s00415-020-10240-8 · Cited by 18
Che, N.-N., Chen, S., Jiang, Q., Chen, S., Zhao, Z., Li, X., Malik, R. A., Ma, J., & Yang, H. (2022) · npj Parkinson s Disease · doi:10.1038/s41531-022-00387-8 · Cited by 17
Bane, A. A., Wilson, L., Jumper, J., Spindler, L., Wyatt, P., & Willoughby, D. S. (2024) · Journal of Parkinson s Disease · doi:10.3233/jpd-230259 · Cited by 17
“Orthostatic hypotension has been defined as a drop in systolic blood pressure by more than 20 mmHg or 10 mmHg diastolic within 3 min of standing [72].”
BackgroundClinical Relevance of Orthostatic Hypotension in Neurodegenerative Disease
McDonell, K. E., Shibao, C. A., & Claassen, D. O. (2015) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-015-0599-0 · Cited by 17
Snapper, H., & Cheshire, W. P. (2022) · Autonomic Neuroscience · doi:10.1016/j.autneu.2022.102951 · Cited by 17
Orthostatic hypotension: revision of the definition is needed
Braam, E. A. J. E., Verbakel, D., Adiyaman, A., & Thien, T. A. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e328331a810 · Cited by 17
Cardiovascular dysautonomia and cognitive impairment in Parkinson's disease (Review)
Khalil, I., Sayad, R., Kedwany, A. M., Sayed, H. H., Caprara, A. L. F., & Rissardo, J. P. (2024) · Medicine International · doi:10.3892/mi.2024.194 · Cited by 19
“OH is characterized by a decrease in systolic BP of at least 20 mmHg or a reduction in diastolic BP of at least 10 mmHg when standing or tilting the head up to at least 60˚ within a period of 3 min (32).”
BackgroundEffects of Tyrosine on Parkinson's Disease: A Randomized, Double‐Blind, Placebo‐Controlled Trial
DiFrancisco‐Donoghue, J., Rabin, E., Lamberg, E. M., & Werner, W. G. (2014) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12082 · Cited by 16
“OH is defined as upon standing for 3 minutes, there is a reduction in systolic blood pressure (SBP) of at least 20 mm Hg or a reduction in diastolic blood pressure (DBP) of at least 10 mm Hg.3,4 OH can cause dizziness, chronic fatigue, decreased quality of life, and increased falls.5 OH affects over 50% of all people…”
BackgroundMethodInfluentialSix‐Month Use of Droxidopa for Neurogenic Orthostatic Hypotension
François, C., Shibao, C. A., Biaggioni, I., Duhig, A. M., McLeod, K., Ogbonnaya, A., Quillen, A., Cannon, J., Padilla, B., Yue, B., et al. (2019) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12726 · Cited by 16
Philips, J., & Scheen, A. J. (2011) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.03.001 · Cited by 17
“Of note squatting has been recommended by the European Federation of the Neurological Societies among the physical measures for the management of patients with orthostatic hypotension (Lahrmann et al., 2006).”
BackgroundPremotor Parkinson's disease: Overview of clinical symptoms and current diagnostic methods
Kaiserová, M., Grambalova, Z., Kurčová, S., Otruba, P., Vranová, H. P., Menšíková, K., & Kaňovský, P. (2021) · Biomedical Papers · doi:10.5507/bp.2021.002 · Cited by 16
Post-Acute Effect of SARS-CoV-2 Infection on the Cardiac Autonomic Function
Salem, A. M., Yar, T., Aleid, M. A., Almahfoudh, H. H., Alsaffar, M. F., Ibrahim, A. A., Almadan, A., Alaidarous, S. M., Almulhim, R. A., Rafique, N., et al. (2022) · International Journal of General Medicine · doi:10.2147/ijgm.s382331 · Cited by 15
“Readings were taken again after 1–2 minutes after the tilt at 70 degrees (Figure 1).(25,26)”
Alterations in cardiovascular autonomic function tests in idiopathic hyperhidrosis
Marinis, M. D., Colaizzo, E., Petrelli, R. A. N., & Santilli, V. (2012) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.11.007 · Cited by 15
Bluvshtein, V., Korczyn, A. D., AKSELROD, S., Pinhas, I., Gelernter, I., & Catz, A. (2010) · Spinal Cord · doi:10.1038/sc.2010.98 · Cited by 15
Orthostatic hypotension: Review and expert position statement
Vidal‐Petiot, E., Pathak, A., Azulay, J.-P., Traon, A. P., & Hanon, O. (2023) · Revue Neurologique · doi:10.1016/j.neurol.2023.11.001 · Cited by 15
Standing orthostatic blood pressure measurements cannot be replaced by sitting measurements
Breeuwsma, A. C., Hartog, L. C., Kamper, A. M., Groenier, K. H., Bilo, H. J. G., Kleefstra, N., & van Hateren, K. J. (2017) · Hypertension Research · doi:10.1038/hr.2017.39 · Cited by 14
Murata, J., Murata, S., Horie, J., Ohtao, H., & Miyazaki, J. (2012) · International journal of gerontology · doi:10.1016/j.ijge.2012.01.011 · Cited by 14
Diagnosis and Management of Autonomic Failure in Neurodegenerative Disorders
Sambati, L., Buonaura, G. C., Doria, A., & Cortelli, P. (2014) · European Neurology · doi:10.1159/000368828 · Cited by 14
Self-citationDrug therapies in older adults (part 2)
Mukhtar, O., & Jackson, S. H. (2015) · Clinical Medicine · doi:10.7861/clinmedicine.15-2-155 · Cited by 13
Mei, S., Wang, X., Mao, W., Liu, Y., Tian, Z., Han, C., & Chan, P. (2024) · npj Parkinson s Disease · doi:10.1038/s41531-024-00787-y · Cited by 13
Tilt-table testing: transient loss of consciousness discriminator or epiphenomenon?
Petkar, S., & Fitzpatrick, A. P. (2008) · EP Europace · doi:10.1093/europace/eun100 · Cited by 13
“Tilt testing may also be useful in the diagnosis of orthostatic intolerance.(35) Carotid sinus hypersensitivity is an important cause of syncope in elderly patients.”
BackgroundSubbarayan, S., Myint, P. K., Martin, K. R., Abraha, I., Devkota, S., O’Mahony, D., Cruz-Jentoft, A. J., Cherubini, A., & Soiza, R. L. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.03.032 · Cited by 13
Palma, J., & Thijs, R. D. (2023) · Journal of Parkinson s Disease · doi:10.3233/jpd-230173 · Cited by 12
“The most disabling manifestation of cardiovascular autonomic dysfunction is OH, defined as a sustained fall in blood pressure (BP) of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing from the supine position [10, 11].”
BackgroundHan, C., Lim, Y.-H., Lee, K., & Hong, Y. (2019) · Environment International · doi:10.1016/j.envint.2019.104941 · Cited by 12
Pasina, L., Casati, M., Cortesi, L., Tettamanti, M., Pellegrini, R., Oppedisano, I., Dugnani, N., Marinou, A., Sforza, G. G. R., & Brucato, A. L. (2019) · Internal and Emergency Medicine · doi:10.1007/s11739-019-02172-7 · Cited by 12
Galizia, G., Abete, P., Testa, G., Vecchio, A. D., Corrà, T., & Nardone, A. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12313 · Cited by 12
“Participants with OH had had more falls in the previous 6 months than those without, which is in keeping with the fact that OH in older adults is considered a risk factor for falls and fall-related injuries.(22,23) On the contrary, there were no differences between participants with and without OH in terms of age, num…”
ResultIncidence of cerebrovascular lesions in pure autonomic failure
Struhal, W., Lahrmann, H., & Mathias, C. J. (2013) · Autonomic Neuroscience · doi:10.1016/j.autneu.2013.04.006 · Cited by 12
“SH may be further aggravated by pharmacological treatment of OH and is thus considered a dose limiting factor (Lahrmann et al., 2006).”
Self-citationBeyond 35 years of Parkinson’s disease: a comprehensive clinical and instrumental assessment
Romagnolo, A., Fabbri, M., Merola, A., Montanaro, E., Palermo, S., Martone, T., Seresini, A., Goldwurm, S., Rizzone, M. G., & Lopiano, L. (2018) · Journal of Neurology · doi:10.1007/s00415-018-8955-z · Cited by 11
Diagnosing Autonomic Nervous System Disorders - Existing Guidelines and Future Perspectives
Lahrmann, H., Rocha, I., Struhal, W., Thijs, R. D., Hilz, M. J., & Neurologist, P. P. (2011) · European Neurological Review · doi:10.17925/enr.2011.06.01.52 · Cited by 11
Self-citationBiswas, D., Karabin, B. L., & Turner, D. (2019) · International Journal of General Medicine · doi:10.2147/ijgm.s170655 · Cited by 11
“Fludrocortisone can also increase the risk of supine hypertension as well as the risk of all-cause hospitalization in comparison with midodrine.(21,50,69) Pyridostigmine is an acetylcholinesterase inhibitor that works by promoting cholinergic signaling at the sympathetic ganglia during orthostatic stress(21) and shows…”
BackgroundPolverino, P., Ajčević, M., Catalan, M., Bertolotti, C., Furlanis, G., Marsich, A., Stella, A. B., Accardo, A., & Manganotti, P. (2022) · Neurological Sciences · doi:10.1007/s10072-022-05972-6 · Cited by 11
“OH is defined by a BP fall greater than 20 mmHg of systolic blood pressure (SBP) and/or 10 mmHg of diastolic blood pressure (DBP) within 3 min of standing from a sitting or supine position [3].”
BackgroundScreening indexes for cardiovascular autonomic failure in Parkinson's disease
Vallelonga, F., Sobrero, G., Giudici, M., Valente, M., Milazzo, V., Stefano, C. D., & Maule, S. V. (2021) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2021.117571 · Cited by 10
Kubota, S., Endo, Y., Kubota, M., Miyazaki, H., & Shigemasa, T. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2021.788954 · Cited by 10
“OH is caused by the shift of blood to lower parts of the body during orthostasis and the consequent lack of proper blood pressure regulation (1, 2).”
BackgroundMethodResultInfluentialThe tilt table test is useful for the diagnosis of vasovagal syncope and should not be abolished
Chrysant, S. G. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13846 · Cited by 9
Orthostatic hypotension: a pragmatic guide to diagnosis and treatment
Gibbon, J. R., & Frith, J. (2020) · Drug and Therapeutics Bulletin · doi:10.1136/dtb.2020.000056 · Cited by 10
Diagnosis and management of neurogenic orthostatic hypotension
Ju, W., & Sinn, D.-I. (2023) · Annals of Clinical Neurophysiology · doi:10.14253/acn.2023.25.2.66 · Cited by 10
“9,10,68 Additionally, high-carbohydrate foods can lead to postprandial hypotension due to shift of blood into the splanchnic circulation.”
BackgroundMwesigwa, N., Vernetti, P. M., Kirabo, A., Black, B. K., Ding, T., Martínez, J. A. B., Palma, J., Biaggioni, I., Kaufmann, H., & Shibao, C. A. (2024) · Clinical Autonomic Research · doi:10.1007/s10286-024-01051-2 · Cited by 9
Chen, K., Du, K., Zhao, Y., Gu, Y., & Zhao, Y. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.762759 · Cited by 9
The Impact of Head-Up Tilt Sleeping on Orthostatic Tolerance: A Scoping Review
van der Stam, A. H., Shmuely, S., de Vries, N. M., Bloem, B. R., & Thijs, R. D. (2023) · Biology · doi:10.3390/biology12081108 · Cited by 9
Cardiac Involvement in Peripheral Neuropathies
Burakgazi, A. Z., & Almahameed, S. (2016) · Journal of Clinical Neuromuscular Disease · doi:10.1097/cnd.0000000000000106 · Cited by 9
Chaos based nonlinear analysis to study cardiovascular responses to changes in posture
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Atomoxetine for Orthostatic Hypotension in an Elderly Patient Over 10 Weeks: A Case Report
Hale, G. M., & Brenner, M. J. (2015) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1635 · Cited by 9
Orthostatic hypotension does not predict recurrent falling in a nursing home population
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“Orthostatic hypotension (OH) is frequently seen in the elderly population, and its prevalence increases with advancing age [1].”
BackgroundMethodDiagnosing orthostatic hypotension with continuous and interval blood pressure measurement devices
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Blood pressure regulation in autonomic failure by dietary sodium, blood volume and posture
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Khandelwal, E., Jaryal, A. K., & Deepak, K. K. (2011) · Europe PMC (PubMed Central) · Cited by 9
Type I Chiari malformation presenting orthostatic syncope who treated with decompressive surgery
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Burden of caregiving for cardiovascular dysautonomia in Parkinson’s disease
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“OH was defined as a sustained reduction of systolic BP ≥ 20 mmHg or diastolic BP ≥ 10 mmHg within 3 min of standing [23].”
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“28,29 The protocol of carotid sinus massage (CSM) per SU was compared to the ‘method of symptoms’.”
MethodOrthostatic Vital Signs After Sport-Related Concussion: A Cohort Study
Sas, A., Popovich, M. J., Gillenkirk, A., Greer, C., Grant, J. A., Almeida, A. A., Ichesco, I. K., Lorincz, M. T., & Eckner, J. T. (2024) · The American Journal of Sports Medicine · doi:10.1177/03635465241270289 · Cited by 8
“21 Although not as sensitive as the gold standard of a heads-up tilt table test, orthostatic VSs have been shown to have a high specificity (86”
Vasovagal Syncope: A Review of Current and Future Strategies
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“Alpha-adrenoceptor agonists Midodrine is a peripherally acting alpha-2 adrenoceptor agonist, which increases BP by venous and arterial vasoconstriction.(41) A randomized, controlled trial has shown that it is beneficial in individuals with tilt-positive frequent syncope, compared with standard care.”
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Autonomic Nervous System: Clinical Testing ☆
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Delayed orthostatic hypotension: A pilot study from India
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Midodrine for severe orthostatic hypotension
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Autonomic dysfunction is frequent and disabling in non-paraneoplastic sensory neuronopathies
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Is Technology for Orthostatic Hypotension Ready for Primetime?
Sarafis, Z. K., Monga, A., Phillips, A. A., & Krassioukov, A. V. (2018) · PM&R · doi:10.1016/j.pmrj.2018.04.011 · Cited by 6
“Fludrocortisone and midodrine exhibit peak blood plasma levels at 45 minutes [35] and 1 hour [124], respectively.”
BackgroundPeters, E., Itani, M., Kristensen, A. G., Terkelsen, A. J., Krøigård, T., Tankişi, H., Jensen, T. S., Finnerup, N. B., & Gylfadottir, S. S. (2023) · Journal of the Peripheral Nervous System · doi:10.1111/jns.12580 · Cited by 6
Han, J., Park, J., Kang, H.-W., Lee, H., & Kim, N. (2023) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000001026 · Cited by 7
Qamar, M. A., Tall, P., van Wamelen, D. J., Wan, Y.-M., Rukavina, K., Fieldwalker, A., Matthew, D., Leta, V., Bannister, K., & Chaudhuri, К. R. (2023) · International review of neurobiology · doi:10.1016/bs.irn.2023.08.012 · Cited by 8
Five Things to Know About Orthostatic Hypotension and Aging
Mills, P. B., Gray, D., & Krassioukov, A. V. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13011 · Cited by 6
“Avoid large, hot meals and alcohol.(10) Physical measures Avoid quick changes in position and exertion in hot weather.”
BackgroundInfluential
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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