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Orthostatic HypotensionII. Clinical Diagnosis, Testing, and Treatment
Irwin J. Schatz, MD
Arch Intern Med. 1984;144(5):1037-1041.
Abstract
• The clinical diagnosis of orthostatic hypotension (OH) is straightforward and usually does not require extensive laboratory testing. Symptoms of cerebral hypoxia may not occur even with low BP because of compensatory cerebral vascular autoregulation. Autonomic function tests may pinpoint the lesion in OH, but they should be selected carefully. Heart rate response to standing, the valsalva maneuver, the cold pressor test, and plasma norepinephrine levels are the most useful. General measures in management, eg, nocturnal head up tilt and use of a pressure-support garment, often will provide major relief of symptoms. The mainstay of drug therapy is fludrocortisone acetate, but edema, supine hypertension, and heart failure occur frequently. Other agents (eg, vasopressors, prostaglandin inhibitors, and β-adrenergic blockers) may enhance effectiveness of therapy when combined with fludrocortisone acetate.
(Arch Intern Med 1984;144:1037-1041)
Author Affiliations
From the Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu.
Footnotes
Accepted for publication Dec 15, 1983.
Reprint requests to the Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana St, Honolulu, HI 96813 (Dr Schatz).
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