Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management

• Published in: Journal of neurology Vol. 260; no. 9; pp. 2212 - 2219
• Main Authors: Metzler, Manuela, Duerr, Susanne, Granata, Roberta, Krismer, Florian, Robertson, David, Wenning, Gregor K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2013; Springer Nature B.V
• Subjects: Atrophy; Blood pressure; Cardiovascular disease; Dementia; Diabetes; Human subjects; Humans; Hypertension; Hypotension, Orthostatic - etiology; Hypotension, Orthostatic - physiopathology; Hypotension, Orthostatic - therapy; Medicine; Medicine & Public Health; Nervous System Diseases - complications; Nervous System Diseases - physiopathology; Nervous System Diseases - therapy; Neurology; Neuroradiology; Neurosciences; Older people; Orthostatic hypotension; Parkinson's disease; Pathophysiology; Review; Multiple system atrophy; Autonomic dysfunction; Neurogenic orthostatic hypotension; Parkinson's disease; Pure autonomic failure; Orthostatic hypotension
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-012-6736-7

Neurogenic orthostatic hypotension is a distinctive and treatable sign of cardiovascular autonomic dysfunction. It is caused by failure of noradrenergic neurotransmission that is associated with a range of primary or secondary autonomic disorders, including pure autonomic failure, Parkinson’s disease with autonomic failure, multiple system atrophy as well as diabetic and nondiabetic autonomic neuropathies. Neurogenic orthostatic hypotension is commonly accompanied by autonomic dysregulation involving other organ systems such as the bowel and the bladder. In the present review, we provide an overview of the clinical presentation, pathophysiology, epidemiology, evaluation and management of neurogenic orthostatic hypotension focusing on neurodegenerative disorders.