Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension

Am J Cardiol. 2020 May 15;125(10):1582-1593. doi: 10.1016/j.amjcard.2020.01.037. Epub 2020 Feb 8.

Abstract

Neurogenic orthostatic hypotension (nOH), a drop in blood pressure upon standing resulting from autonomic malfunction, may cause debilitating symptoms that can affect independence in daily activities and quality-of-life. nOH may also be associated with cardiovascular comorbidities (e.g., supine hypertension, heart failure, diabetes, and arrhythmias), making treatment decisions complicated and requiring management that should be based on a patient's cardiovascular profile. Additionally, drugs used to treat the cardiovascular disorders (e.g., vasodilators, β-blockers) can exacerbate nOH and concomitant symptoms. When orthostatic symptoms are severe and not effectively managed with nonpharmacologic strategies (e.g., water ingestion, abdominal compression), droxidopa or midodrine may be effective. Droxidopa may be less likely than midodrine to exacerbate supine hypertension, based on conclusions of a limited meta-analysis. In conclusion, treating nOH in patients with cardiovascular conditions requires a balance between symptom relief and minimizing adverse outcomes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiovascular System / physiopathology*
  • Droxidopa / therapeutic use
  • Humans
  • Hypotension, Orthostatic / physiopathology*
  • Hypotension, Orthostatic / therapy*
  • Midodrine / therapeutic use
  • Sympathomimetics / therapeutic use

Substances

  • Sympathomimetics
  • Midodrine
  • Droxidopa