What are the common causes of, and the treatment options for, neurogenic orthostatic hypertension?
Neurogenic orthostatic hypotension is a distinctive and often treatable sign of cardiovascular autonomic dysfunction. It is caused by a failure of noradrenergic neurotransmission, and is most often associated with diabetic neuropathy, Parkinson disease, dementia with Lewy bodies, multiple system atrophy, or pure autonomic failure (in order of increasing risk). It has a prevalence of 5% to 30% in older, general US populations. The loss of homeostatic mechanisms to control blood pressure fluctuations raises blood pressure while supine, while causing orthostatic hypotension, typically within 6 seconds after assuming a seated or standing position. These changes are most easily demonstrated during a tilt-table test. Affected patients often need short-acting antihypertensive medications (e.g., clonidine) at bedtime and stimulants (e.g., midodrine, droxidopa) during the day.