Orthostatic Hypotension: Mechanisms, Causes, Management
Journal of Clinical Neurology
;
: 220-226, 2015.
Artigo
em Inglês
| WPRIM
| ID: wpr-165910
ABSTRACT
Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fails. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. OH is common in the elderly and is associated with an increase in mortality rate. There are many causes of OH. Aging coupled with diseases such as diabetes and Parkinson's disease results in a prevalence of 10-30% in the elderly. These conditions cause baroreflex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP. The treatment of OH is imperfect since it is impossible to normalize standing BP without generating excessive supine hypertension. The practical goal is to improve standing BP so as to minimize symptoms and to improve standing time in order to be able to undertake orthostatic activities of daily living, without excessive supine hypertension. It is possible to achieve these goals with a combination of fludrocortisone, a pressor agent (midodrine or droxidopa), supplemented with procedures to improve orthostatic defenses during periods of increased orthostatic stress. Such procedures include water bolus treatment and physical countermaneuvers. We provide a pragmatic guide on patient education and the patient-orientated approach to the moment to moment management of OH.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Doença de Parkinson
/
Volume Sanguíneo
/
Atividades Cotidianas
/
Envelhecimento
/
Fludrocortisona
/
Água
/
Educação de Pacientes como Assunto
/
Prevalência
/
Mortalidade
/
Barorreflexo
Tipo de estudo:
Estudo de etiologia
/
Estudo de prevalência
/
Estudo prognóstico
Limite:
Idoso
/
Humanos
Idioma:
Inglês
Revista:
Journal of Clinical Neurology
Ano de publicação:
2015
Tipo de documento:
Artigo
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