EFNS guidelines on the diagnosis and management of orthostatic hypotension

H. Lahrmann, P. Cortelli, M. Hilz, C. J. Mathias, W. Struhal, M. Tassinari

Research output: Contribution to journalArticle

203 Citations (Scopus)

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 languageEnglish
Pages (from-to)930-936
Number of pages7
JournalEuropean Journal of Neurology
Volume13
Issue number9
DOIs
Publication statusPublished - Sep 2006

Fingerprint

Orthostatic Hypotension
Guidelines
Blood Pressure
Midodrine
Fludrocortisone
Ephedrine
Sympathomimetics
Unconsciousness
Supine Position
Syncope
Dizziness
Leg
Salts
Eating
Heart Rate
History
Head
Pharmacology
Exercise
Hypertension

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 journalArticle

Lahrmann, H. ; Cortelli, P. ; Hilz, M. ; Mathias, C. J. ; Struhal, W. ; Tassinari, M. / EFNS guidelines on the diagnosis and management of orthostatic hypotension. In: European Journal of Neurology. 2006 ; Vol. 13, No. 9. pp. 930-936.
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