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- W4320006586 abstract "Orthostatic hypotension (OH) impairs quality of life, is a frequent cause of falls, syncope and hospitalizations, and is an independent risk factor of mortality. This chapter presents an overview of the evaluation and management in OH patients, based on our understanding of the underlying pathophysiology and relevant clinical pharmacology. Individual treatment approaches are discussed in subsequent chapters. Patients with neurogenic OH can have profound drops in blood pressure from seemingly trivial stimuli because of denervation hypersensitivity, and the first step is to manage aggravating factors such as meals (postprandial hypotension) and medications. Patients should avoid the supine posture during the day because pressure diuresis can worsen OH. Conversely, sleeping in a head up tilt position can reduce nocturnal diuresis and improve orthostatic tolerance. The goal when using pressor agents should not be to “normalize” upright blood pressure but to elevate it above the threshold of cerebral autoregulation that triggers symptoms. Patients with peripheral forms of disease (pure autonomic failure) tend to have low “sympathetic reserve”, and can be treated with direct adrenergic agonists such as midodrine and droxidopa (“norepinephrine replacers”). On the other hand, patients with preserved “sympathetic reserve” (multiple system atrophy) may benefit from harnessing their endogenous sympathetic activity either by increasing central sympathetic outflow with yohimbine, by facilitating neurotransmission at the level of autonomic ganglia with pyridostigmine, by or increasing synaptic norepinephrine with the norepinephrine transporter blocker atomoxetine (“norepinephrine enhancers”)." @default.
- W4320006586 created "2023-02-11" @default.
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- W4320006586 date "2023-01-01" @default.
- W4320006586 modified "2023-09-30" @default.
- W4320006586 title "Management of orthostatic hypotension. Introduction" @default.
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- W4320006586 doi "https://doi.org/10.1016/b978-0-323-85492-4.00014-4" @default.
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