Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 930-936 |
| Number of pages | 7 |
| Journal | European Journal of Neurology |
| Volume | 13 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - Sep 2006 |
Fingerprint
Keywords
- Autonomic nervous system
- Diagnosis
- Guidelines
- Head up tilt test
- Management
- Orthostatic hypotension
ASJC Scopus subject areas
- Clinical Neurology
- Neuroscience(all)
Cite this
EFNS guidelines on the diagnosis and management of orthostatic hypotension. / Lahrmann, H.; Cortelli, P.; Hilz, M.; Mathias, C. J.; Struhal, W.; Tassinari, M.
In: European Journal of Neurology, Vol. 13, No. 9, 09.2006, p. 930-936.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - EFNS guidelines on the diagnosis and management of orthostatic hypotension
AU - Lahrmann, H.
AU - Cortelli, P.
AU - Hilz, M.
AU - Mathias, C. J.
AU - Struhal, W.
AU - Tassinari, M.
PY - 2006/9
Y1 - 2006/9
N2 - 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.
AB - 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.
KW - Autonomic nervous system
KW - Diagnosis
KW - Guidelines
KW - Head up tilt test
KW - Management
KW - Orthostatic hypotension
UR - http://www.scopus.com/inward/record.url?scp=33747865174&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33747865174&partnerID=8YFLogxK
U2 - 10.1111/j.1468-1331.2006.01512.x
DO - 10.1111/j.1468-1331.2006.01512.x
M3 - Article
C2 - 16930356
AN - SCOPUS:33747865174
VL - 13
SP - 930
EP - 936
JO - European Journal of Neurology
JF - European Journal of Neurology
SN - 1351-5101
IS - 9
ER -