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Orthostatic Hypotension : Management of a Complex, But Common, Medical Problem

Fedorowski, Artur LU orcid ; Ricci, Fabrizio LU ; Hamrefors, Viktor LU orcid ; Sandau, Kristin E ; Hwan Chung, Tae ; Muldowney, James A S ; Gopinathannair, Rakesh and Olshansky, Brian (2022) In Circulation: Arrhythmia and Electrophysiology 15(3).
Abstract

Orthostatic hypotension (OH), a common, often overlooked, disorder with many causes, is associated with debilitating symptoms, falls, syncope, cognitive impairment, and risk of death. Chronic OH, a cardinal sign of autonomic dysfunction, increases with advancing age and is commonly associated with neurodegenerative and autoimmune diseases, diabetes, hypertension, heart failure, and kidney failure. Management typically involves a multidisciplinary, patient-centered, approach to arrive at an appropriate underlying diagnosis that is causing OH, treating accompanying conditions, and providing individually tailored pharmacological and nonpharmacological treatment. We (1) propose a novel streamlined pathophysiological classification of OH;... (More)

Orthostatic hypotension (OH), a common, often overlooked, disorder with many causes, is associated with debilitating symptoms, falls, syncope, cognitive impairment, and risk of death. Chronic OH, a cardinal sign of autonomic dysfunction, increases with advancing age and is commonly associated with neurodegenerative and autoimmune diseases, diabetes, hypertension, heart failure, and kidney failure. Management typically involves a multidisciplinary, patient-centered, approach to arrive at an appropriate underlying diagnosis that is causing OH, treating accompanying conditions, and providing individually tailored pharmacological and nonpharmacological treatment. We (1) propose a novel streamlined pathophysiological classification of OH; (2) review the relationship between the cardiovascular disease continuum and OH; (3) discuss OH-mediated end-organ damage; (4) provide diagnostic and therapeutic algorithms to guide clinical decision making and patient care; (5) identify current gaps in knowledge and try to define future research directions. Using a case-based learning approach, specific clinical scenarios are presented highlighting various presentations of OH to provide a practical guide to evaluate and manage patients who have OH.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Circulation: Arrhythmia and Electrophysiology
volume
15
issue
3
article number
E010573
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85126831022
  • pmid:35212554
ISSN
1941-3084
DOI
10.1161/CIRCEP.121.010573
language
English
LU publication?
yes
id
c4684a74-7306-46ec-9e28-928276123199
date added to LUP
2022-03-04 21:02:14
date last changed
2025-03-11 00:00:39
@article{c4684a74-7306-46ec-9e28-928276123199,
  abstract     = {{<p>Orthostatic hypotension (OH), a common, often overlooked, disorder with many causes, is associated with debilitating symptoms, falls, syncope, cognitive impairment, and risk of death. Chronic OH, a cardinal sign of autonomic dysfunction, increases with advancing age and is commonly associated with neurodegenerative and autoimmune diseases, diabetes, hypertension, heart failure, and kidney failure. Management typically involves a multidisciplinary, patient-centered, approach to arrive at an appropriate underlying diagnosis that is causing OH, treating accompanying conditions, and providing individually tailored pharmacological and nonpharmacological treatment. We (1) propose a novel streamlined pathophysiological classification of OH; (2) review the relationship between the cardiovascular disease continuum and OH; (3) discuss OH-mediated end-organ damage; (4) provide diagnostic and therapeutic algorithms to guide clinical decision making and patient care; (5) identify current gaps in knowledge and try to define future research directions. Using a case-based learning approach, specific clinical scenarios are presented highlighting various presentations of OH to provide a practical guide to evaluate and manage patients who have OH.</p>}},
  author       = {{Fedorowski, Artur and Ricci, Fabrizio and Hamrefors, Viktor and Sandau, Kristin E and Hwan Chung, Tae and Muldowney, James A S and Gopinathannair, Rakesh and Olshansky, Brian}},
  issn         = {{1941-3084}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{3}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Circulation: Arrhythmia and Electrophysiology}},
  title        = {{Orthostatic Hypotension : Management of a Complex, But Common, Medical Problem}},
  url          = {{http://dx.doi.org/10.1161/CIRCEP.121.010573}},
  doi          = {{10.1161/CIRCEP.121.010573}},
  volume       = {{15}},
  year         = {{2022}},
}