Author + information
- Received May 26, 2017
- Revision received May 8, 2018
- Accepted May 22, 2018
- Published online September 3, 2018.
- Roy Freeman, MDa,∗ (, )@BIDMCHealth,
- Ahmad R. Abuzinadah, MDb,
- Christopher Gibbons, MD, MPHa,
- Pearl Jones, MDc,
- Mitchell G. Miglis, MDd and
- Dong In Sinn, MDd
- aDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- bKing Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
- cLotus Spine and Pain, San Antonio, Texas
- dDepartment of Neurology, Stanford Medical Center, Palo Alto, California
- ↵∗Address for correspondence:
Dr. Roy Freeman, Autonomic and Peripheral Nerve Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, Massachusetts 02215.
Neurogenic orthostatic hypotension is a highly prevalent and disabling feature of autonomic failure due to both peripheral and central neurodegenerative diseases. Community-based epidemiological studies have demonstrated a high morbidity and mortality associated with neurogenic orthostatic hypotension. It is due to impairment of baroreflex-mediated vasoconstriction of the skeletal muscle and splanchnic circulation and is caused by damage or dysfunction at central and/or peripheral sites in the baroreflex efferent pathway. Nonpharmacological and pharmacological interventions may be implemented to ameliorate the symptoms of orthostatic intolerance and improve quality of life. Many patients will be adequately treated by education, counseling, removal of hypotensive medications, and other nonpharmacological interventions, whereas more severely afflicted patients require pharmacological interventions. The first stage of pharmacological treatment involves repletion of central blood volume. If unsuccessful, this should be followed by treatment with sympathomimetic agents.
Drs. Freeman, Gibbons, and Miglis have received personal compensation for serving on the Lundbeck Scientific Advisory Board. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 26, 2017.
- Revision received May 8, 2018.
- Accepted May 22, 2018.
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