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Management of Neurogenic Orthostatic Hypotension in Patients with Autonomic Failure

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Abstract

The maintenance of blood pressure in the upright position requires intact autonomic cardiovascular reflexes. Diseases that affect the sympathetic innervation of the cardiovascular system result in a sustained fall in blood pressure upon standing (i.e., neurogenic orthostatic hypotension) that can impair the blood supply to the brain and other organs and cause considerable morbidity and mortality. Here we review treatment options for neurogenic orthostatic hypotension and include an algorithm for its management that emphasizes the importance of non-pharmacologic measures and provides guidance on pharmacologic treatment options.

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References

  1. Smit AA, Halliwill JR, Low PA, Wieling W. Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol. 1999;519(Pt 1):1–10.

    PubMed  CAS  Google Scholar 

  2. Matzen S, Perko G, Groth S, Friedman DB, Secher NH. Blood volume distribution during head-up tilt induced central hypovolaemia in man. Clin Physiol. 1991;11(5):411–22.

    PubMed  CAS  Google Scholar 

  3. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72.

    PubMed  Google Scholar 

  4. Lahrmann H, Cortelli P, Hilz M, Mathias CJ, Struhal W, Tassinari M. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur J Neurol. 2006;13(9):930–6.

    PubMed  CAS  Google Scholar 

  5. Masaki KH, Schatz IJ, Burchfiel CM, Sharp DS, Chiu D, Foley D, et al. Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation. 1998;98(21):2290–5.

    PubMed  CAS  Google Scholar 

  6. Rose KM, Eigenbrodt ML, Biga RL, Couper DJ, Light KC, Sharrett AR, et al. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation. 2006;114(7):630–6.

    PubMed  Google Scholar 

  7. Ganjehei L, Massumi A, Razavi M, Wilson JM. Orthostatic hypotension as a manifestation of vitamin B12 deficiency. Tex Heart Inst J. 2012;39(5):722–3.

    PubMed  Google Scholar 

  8. Girard P, Lebrun C, Peyrade F, Brunetto JL, Chatel M. Orthostatic hypotension revealing vitamin B12 deficiency. Rev Neurol (Paris). 1998;154(4):342–4.

    CAS  Google Scholar 

  9. Moore A, Ryan J, Watts M, Pillay I, Clinch D, Lyons D. Orthostatic tolerance in older patients with vitamin B12 deficiency before and after vitamin B12 replacement. Clin Auton Res. 2004;14(2):67–71.

    PubMed  Google Scholar 

  10. Graber JJ, Sherman FT, Kaufmann H, Kolodny EH, Sathe S. Vitamin B12-responsive severe leukoencephalopathy and autonomic dysfunction in a patient with “normal” serum B12 levels. J Neurol Neurosurg Psychiatry. 2010;81(12):1369–71.

    PubMed  CAS  Google Scholar 

  11. Vernino S. Autoimmune and paraneoplastic channelopathies. Neurotherapeutics. 2007;4(2):305–14.

    PubMed  CAS  Google Scholar 

  12. Schroeder C, Vernino S, Birkenfeld AL, Tank J, Heusser K, Lipp A, et al. Plasma exchange for primary autoimmune autonomic failure. N Engl J Med. 2005;353(15):1585–90.

    PubMed  CAS  Google Scholar 

  13. Metzler M, Duerr S, Granata R, Krismer F, Robertson D, Wenning GK. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management. J Neurol. Epub 2012 Nov 20.

  14. Robertson D. The pathophysiology and diagnosis of orthostatic hypotension. Clin Auton Res. 2008;18(Suppl. 1):2–7.

    PubMed  Google Scholar 

  15. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139–46.

    PubMed  Google Scholar 

  16. Kollensperger M, Geser F, Ndayisaba JP, Boesch S, Seppi K, Ostergaard K, et al. Presentation, diagnosis, and management of multiple system atrophy in Europe: final analysis of the European multiple system atrophy registry. Mov Disord. 2010;25(15):2604–12.

    PubMed  Google Scholar 

  17. Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, et al. The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol. 2013;12(3):264–74.

    PubMed  Google Scholar 

  18. Kaufmann H, Biaggioni I. Autonomic failure in neurodegenerative disorders. Semin Neurol. 2003;23(4):351–63.

    PubMed  Google Scholar 

  19. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology. 1996;46(5):1470.

    Google Scholar 

  20. Senard JM, Rai S, Lapeyre-Mestre M, Brefel C, Rascol O, Rascol A, et al. Prevalence of orthostatic hypotension in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1997;63(5):584–9.

    PubMed  CAS  Google Scholar 

  21. Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002;72(6):721–5.

    PubMed  CAS  Google Scholar 

  22. Velseboer DC, de Haan RJ, Wieling W, Goldstein DS, de Bie RM. Prevalence of orthostatic hypotension in Parkinson’s disease: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2011;17(10):724–9.

    PubMed  Google Scholar 

  23. Thaisetthawatkul P, Boeve BF, Benarroch EE, Sandroni P, Ferman TJ, Petersen R, et al. Autonomic dysfunction in dementia with Lewy bodies. Neurology. 2004;62(10):1804–9.

    PubMed  CAS  Google Scholar 

  24. Sonnesyn H, Nilsen DW, Rongve A, Nore S, Ballard C, Tysnes OB, et al. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord. 2009;28(4):307–13.

    PubMed  Google Scholar 

  25. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615–24.

    PubMed  CAS  Google Scholar 

  26. Freeman R. Autonomic peripheral neuropathy. Lancet. 2005;365(9466):1259–70.

    PubMed  CAS  Google Scholar 

  27. Low PA. Prevalence of orthostatic hypotension. Clin Auton Res. 2008;18(Suppl. 1):8–13.

    PubMed  Google Scholar 

  28. Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther. 2005;30(2):173–8.

    PubMed  CAS  Google Scholar 

  29. Barochiner J, Alfie J, Aparicio L, Rada M, Morales M, Cuffaro P, et al. Orthostatic hypotension in treated hypertensive patients. Rom J Intern Med. 2012;50(3):203–9.

    PubMed  Google Scholar 

  30. Darowski A, Chambers SA, Chambers DJ. Antidepressants and falls in the elderly. Drugs Aging. 2009;26(5):381–94.

    PubMed  CAS  Google Scholar 

  31. Mackin P. Cardiac side effects of psychiatric drugs. Hum Psychopharmacol. 2008;23(Suppl. 1):3–14.

    PubMed  CAS  Google Scholar 

  32. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: as easy as A, B, C. Cleve Clin J Med. 2010;77(5):298–306.

    PubMed  Google Scholar 

  33. Podoleanu C, Maggi R, Brignole M, Croci F, Incze A, Solano A, et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons: a randomized single-blind controlled study. J Am Coll Cardiol. 2006;48(7):1425–32.

    PubMed  Google Scholar 

  34. Tutaj M, Marthol H, Berlin D, Brown CM, Axelrod FB, Hilz MJ. Effect of physical countermaneuvers on orthostatic hypotension in familial dysautonomia. J Neurol. 2006;253(1):65–72.

    PubMed  Google Scholar 

  35. ten Harkel AD, van Lieshout JJ, Wieling W. Effects of leg muscle pumping and tensing on orthostatic arterial pressure: a study in normal subjects and patients with autonomic failure. Clin Sci (Lond). 1994;87(5):553–8.

    Google Scholar 

  36. Bouvette CM, McPhee BR, Opfer-Gehrking TL, Low PA. Role of physical countermaneuvers in the management of orthostatic hypotension: efficacy and biofeedback augmentation. Mayo Clin Proc. 1996;71(9):847–53.

    PubMed  CAS  Google Scholar 

  37. Freeman R. Treatment of orthostatic hypotension. Semin Neurol. 2003;23(4):435–42.

    PubMed  Google Scholar 

  38. Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens (Greenwich). 2002;4(2):139–45.

    Google Scholar 

  39. Vagaonescu TD, Saadia D, Tuhrim S, Phillips RA, Kaufmann H. Hypertensive cardiovascular damage in patients with primary autonomic failure. Lancet. 2000;355(9205):725–6.

    PubMed  CAS  Google Scholar 

  40. Kronenberg MW, Forman MB, Onrot J, Robertson D. Enhanced left ventricular contractility in autonomic failure: assessment using pressure–volume relations. J Am Coll Cardiol. 1990;15(6):1334–42.

    PubMed  CAS  Google Scholar 

  41. MacLean AR, Allen BV. Orthostatic hypotension and orthostatic tachycardia: treatment with the “head-up” bed. JAMA. 1940;115(25):2162–7.

    Google Scholar 

  42. ten Harkel AD, van Lieshout JJ, Wieling W. Treatment of orthostatic hypotension with sleeping in the head-up tilt position, alone and in combination with fludrocortisone. J Intern Med. 1992;232(2):139–45.

    PubMed  Google Scholar 

  43. Fan CW, Gasparro D, Crowley V, Cunningham CJ. Acute haemodynamic response to sleeping head-up at 6 inches in older inpatients. Clin Auton Res. 2009;19(1):51–7.

    PubMed  Google Scholar 

  44. Arnold AC, Biaggioni I. Management approaches to hypertension in autonomic failure. Curr Opin Nephrol Hypertens. 2012;21(5):481–5.

    PubMed  Google Scholar 

  45. Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D, et al. Water drinking as a treatment for orthostatic syndromes. Am J Med. 2002;112(5):355–60.

    PubMed  Google Scholar 

  46. Deguchi K, Ikeda K, Sasaki I, Shimamura M, Urai Y, Tsukaguchi M, et al. Effects of daily water drinking on orthostatic and postprandial hypotension in patients with multiple system atrophy. J Neurol. 2007;254(6):735–40.

    PubMed  Google Scholar 

  47. Humm AM, Mason LM, Mathias CJ. Effects of water drinking on cardiovascular responses to supine exercise and on orthostatic hypotension after exercise in pure autonomic failure. J Neurol Neurosurg Psychiatry. 2008;79(10):1160–4.

    PubMed  CAS  Google Scholar 

  48. May M, Jordan J. The osmopressor response to water drinking. Am J Physiol Regul Integr Comp Physiol. 2011;300(1):R40–6.

    PubMed  CAS  Google Scholar 

  49. Raj SR, Biaggioni I, Black BK, Rali A, Jordan J, Taneja I, et al. Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension. Hypertension. 2006;48(2):329–34.

    PubMed  CAS  Google Scholar 

  50. Jordan J, Shannon JR, Black BK, Ali Y, Farley M, Costa F, et al. The pressor response to water drinking in humans: a sympathetic reflex? Circulation. 2000;101(5):504–9.

    PubMed  CAS  Google Scholar 

  51. Z’Graggen WJ, Hess CW, Humm AM. Acute fluid ingestion in the treatment of orthostatic intolerance—important implications for daily practice. Eur J Neurol. 2010;17(11):1370–6.

    PubMed  Google Scholar 

  52. Logan IC, Witham MD. Efficacy of treatments for orthostatic hypotension: a systematic review. Age Ageing. 2012;41(5):587–94.

    PubMed  Google Scholar 

  53. Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, et al. The movement disorder society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26(Suppl. 3):S42–80.

    PubMed  Google Scholar 

  54. Gibbons CH, Raj SR. A meta-analysis of pharmacologic treatments of orthostatic hypotension [abstract]. Clin Auton Res. 2012;22(5):231–2.

    Google Scholar 

  55. Jordan J, Shannon JR, Biaggioni I, Norman R, Black BK, Robertson D. Contrasting actions of pressor agents in severe autonomic failure. Am J Med. 1998;105(2):116–24.

    PubMed  CAS  Google Scholar 

  56. Low PA, Gilden JL, Freeman R, Sheng KN, McElligott MA. Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension: a randomized, double-blind multicenter study. Midodrine Study Group. JAMA. 1997;277(13):1046–51.

    PubMed  CAS  Google Scholar 

  57. Jankovic J, Gilden JL, Hiner BC, Kaufmann H, Brown DC, Coghlan CH, et al. Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine. Am J Med. 1993;95(1):38–48.

    PubMed  CAS  Google Scholar 

  58. Wright RA, Kaufmann HC, Perera R, Opfer-Gehrking TL, McElligott MA, Sheng KN, et al. A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension. Neurology. 1998;51(1):120–4.

    PubMed  CAS  Google Scholar 

  59. Fouad-Tarazi FM, Okabe M, Goren H. Alpha sympathomimetic treatment of autonomic insufficiency with orthostatic hypotension. Am J Med. 1995;99(6):604–10.

    PubMed  CAS  Google Scholar 

  60. Hoeldtke RD, Horvath GG, Bryner KD, Hobbs GR. Treatment of orthostatic hypotension with midodrine and octreotide. J Clin Endocrinol Metab. 1998;83(2):339–43.

    PubMed  CAS  Google Scholar 

  61. Kaufmann H, Brannan T, Krakoff L, Yahr MD, Mandeli J. Treatment of orthostatic hypotension due to autonomic failure with a peripheral alpha-adrenergic agonist (midodrine). Neurology. 1988;38(6):951–6.

    PubMed  CAS  Google Scholar 

  62. Steinbach K, Weidinger P. Effect of midodrin on orthostasis. Wien Klin Wochenschr. 1973;85(38):621–4.

    PubMed  CAS  Google Scholar 

  63. Zachariah PK, Bloedow DC, Moyer TP, Sheps SG, Schirger A, Fealey RD. Pharmacodynamics of midodrine, an antihypotensive agent. Clin Pharmacol Ther. 1986;39(5):586–91.

    PubMed  CAS  Google Scholar 

  64. Schirger A, Sheps SG, Thomas JE, Fealey RD. Midodrine: a new agent in the management of idiopathic orthostatic hypotension and Shy-Drager syndrome. Mayo Clin Proc. 1981;56(7):429–33.

    PubMed  CAS  Google Scholar 

  65. Cruz DN. Midodrine: a selective alpha-adrenergic agonist for orthostatic hypotension and dialysis hypotension. Expert Opin Pharmacother. 2000;1(4):835–40.

    PubMed  CAS  Google Scholar 

  66. Pohl K, Kriech W. Therapy of orthostatic disorders of cardiovascular regulation: placebo controlled double-blind study with oxilofrine. Fortschr Med. 1991;109(33):685–8.

    PubMed  CAS  Google Scholar 

  67. Freistuhler M, Passenberg P, Burger M. The Shy-Drager syndrome. Dtsch Med Wochenschr. 1992;117(30):1146–8.

    PubMed  CAS  Google Scholar 

  68. Gemeinhardt S, Schardt F, Polzien P. Abnormalities of hypotonic orthostatic regulation: cardiovascular effects of dihydroergotamine, etilefrine and their combination [author’s transl]. Dtsch Med Wochenschr. 1981;106(35):1095–9.

    PubMed  CAS  Google Scholar 

  69. Broadley KJ. The vascular effects of trace amines and amphetamines. Pharmacol Ther. 2010;125(3):363–75.

    PubMed  CAS  Google Scholar 

  70. Robertson D, Hollister AS, Carey EL, Tung CS, Goldberg MR, Robertson RM. Increased vascular beta2-adrenoceptor responsiveness in autonomic dysfunction. J Am Coll Cardiol. 1984;3(3):850–6.

    PubMed  CAS  Google Scholar 

  71. Kernan WN, Viscoli CM, Brass LM, Broderick JP, Brott T, Feldmann E, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med. 2000;343(25):1826–32.

    PubMed  CAS  Google Scholar 

  72. Mathias CJ. l-Dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension: the European experience. Clin Auton Res. 2008;18(Suppl. 1):25–9.

    PubMed  Google Scholar 

  73. Kaufmann H. l-Dihydroxyphenylserine (Droxidopa): a new therapy for neurogenic orthostatic hypotension: the US experience. Clin Auton Res. 2008;18(Suppl. 1):19–24.

    PubMed  Google Scholar 

  74. Man in ‘t Veld AJ, Boomsma F, van den Meiracker AH, Schalekamp MA. Effect of unnatural noradrenaline precursor on sympathetic control and orthostatic hypotension in dopamine-beta-hydroxylase deficiency. Lancet. 1987;2(8569):1172–5.

    PubMed  Google Scholar 

  75. Mathias CJ, Bannister RB, Cortelli P, Heslop K, Polak JM, Raimbach S, et al. Clinical, autonomic and therapeutic observations in two siblings with postural hypotension and sympathetic failure due to an inability to synthesize noradrenaline from dopamine because of a deficiency of dopamine beta hydroxylase. Q J Med. 1990;75(278):617–33.

    PubMed  CAS  Google Scholar 

  76. Robertson D, Goldberg MR, Onrot J, Hollister AS, Wiley R, Thompson JG Jr, et al. Isolated failure of autonomic noradrenergic neurotransmission: evidence for impaired beta-hydroxylation of dopamine. N Engl J Med. 1986;314(23):1494–7.

    PubMed  CAS  Google Scholar 

  77. Garland EM, Raj SR, Demartinis N, Robertson D. Case report: marathon runner with severe autonomic failure. Lancet. 2005;366(Suppl. 1):S13.

    PubMed  Google Scholar 

  78. Mathias CJ, Senard JM, Braune S, Watson L, Aragishi A, Keeling JE, et al. l-Threo-dihydroxyphenylserine (l-threo-DOPS; droxidopa) in the management of neurogenic orthostatic hypotension: a multi-national, multi-center, dose-ranging study in multiple system atrophy and pure autonomic failure. Clin Auton Res. 2001;11(4):235–42.

    PubMed  CAS  Google Scholar 

  79. Kaufmann H, Saadia D, Voustianiouk A, Goldstein DS, Holmes C, Yahr MD, et al. Norepinephrine precursor therapy in neurogenic orthostatic hypotension. Circulation. 2003;108(6):724–8.

    PubMed  CAS  Google Scholar 

  80. Mathias CJ, Senard JM, Cortelli P. A double-blind, randomized, placebo-controlled study to determine the efficacy and safety of droxidopa in the treatment of orthostatic hypotension associated with multiple system atrophy or Parkinson’s disease [abstract]. Clin Auton Res. 2007;17(272).

  81. Kaufmann H, Freeman R, Biaggioni I, Low PA, Pedder S, Hewitt A, et al. Treatment of neurogenic orthostatic hypotension with droxidopa: results from a multi-center, double-blind, randomized, placebo-controlled, parallel group, induction design study [abstract]. Neurology. 2012;78(Suppl. 1):4–22.

    Google Scholar 

  82. Singer W, Opfer-Gehrking TL, McPhee BR, Hilz MJ, Bharucha AE, Low PA. Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension. J Neurol Neurosurg Psychiatry. 2003;74(9):1294–8.

    PubMed  CAS  Google Scholar 

  83. Singer W, Sandroni P, Opfer-Gehrking TL, Suarez GA, Klein CM, Hines S, et al. Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Arch Neurol. 2006;63(4):513–8.

    PubMed  Google Scholar 

  84. Sandroni P, Opfer-Gehrking TL, Singer W, Low PA. Pyridostigmine for treatment of neurogenic orthostatic hypotension [correction of hypertension]—a follow-up survey study. Clin Auton Res. 2005;15(1):51–3.

    PubMed  Google Scholar 

  85. Shibao C, Okamoto LE, Gamboa A, Yu C, Diedrich A, Raj SR, et al. Comparative efficacy of yohimbine against pyridostigmine for the treatment of orthostatic hypotension in autonomic failure. Hypertension. 2010;56(5):847–51.

    PubMed  CAS  Google Scholar 

  86. Grossman E, Rea RF, Hoffman A, Goldstein DS. Yohimbine increases sympathetic nerve activity and norepinephrine spillover in normal volunteers. Am J Physiol. 1991;260(1 Pt 2):R142–7.

    PubMed  CAS  Google Scholar 

  87. Senard JM, Rascol O, Durrieu G, Tran MA, Berlan M, Rascol A, et al. Effects of yohimbine on plasma catecholamine levels in orthostatic hypotension related to Parkinson disease or multiple system atrophy. Clin Neuropharmacol. 1993;16(1):70–6.

    PubMed  CAS  Google Scholar 

  88. Sharabi Y, Eldadah B, Li ST, Dendi R, Pechnik S, Holmes C, et al. Neuropharmacologic distinction of neurogenic orthostatic hypotension syndromes. Clin Neuropharmacol. 2006;29(3):97–105.

    PubMed  Google Scholar 

  89. Kochar MS, Itskovitz HD. Treatment of idiopathic orthostatic hypotension (Shy-Drager syndrome) with indomethacin. Lancet. 1978;1(8072):1011–4.

    PubMed  CAS  Google Scholar 

  90. Abate G, Polimeni RM, Cuccurullo F, Puddu P, Lenzi S. Effects of indomethacin on postural hypotension in Parkinsonism. Br Med J. 1979;2(6203):1466–8.

    PubMed  CAS  Google Scholar 

  91. Watt SJ, Tooke JE, Perkins CM, Lee MR. The treatment of idiopathic orthostatic hypotension: a combined fludrocortisone and flurbiprofen regime. Q J Med. 1981;50(198):205–12.

    PubMed  CAS  Google Scholar 

  92. Aellig WH. Direct effects of vasoactive substances on superficial human veins in vivo. Int Angiol. 1985;4(2):235–42.

    PubMed  CAS  Google Scholar 

  93. Muth HH, Jansen W. Dihydroergot plus in the long-term therapy of orthostatic hypotonic dysregulation in older patients. Fortschr Med. 1980;98(40):1571–4.

    PubMed  CAS  Google Scholar 

  94. Lang E. Orthostatic hypotension in the aged. Cardiology. 1976;61(Suppl. 1):225–35.

    PubMed  Google Scholar 

  95. Thulesius O, Berlin E. Dihydroergotamine therapy in orthostatic hypotension due to psychotropic drugs. Int J Clin Pharmacol Ther Toxicol. 1986;24(9):465–7.

    PubMed  CAS  Google Scholar 

  96. Mannelli M, Pupilli C, Fabbri G, Musante R, De Feo ML, Franchi F, et al. Endogenous dopamine (DA) and DA2 receptors: a mechanism limiting excessive sympathetic-adrenal discharge in humans. J Clin Endocrinol Metab. 1988;66(3):626–31.

    PubMed  CAS  Google Scholar 

  97. Magnifico F, Pierangeli G, Barletta G, Candela C, Bonavina G, Contin M, et al. The cardiovascular effects of metoclopramide in multiple system atrophy and pure autonomic failure. Clin Auton Res. 2001;11(3):163–8.

    PubMed  CAS  Google Scholar 

  98. Destee A, Leys D, Delisse B, Warot P. Orthostatic hypotension due to diabetic autonomic neuropathy? Treatment with domperidone. Arch Neurol. 1987;44(1):11.

    PubMed  CAS  Google Scholar 

  99. Schoffer KL, Henderson RD, O’Maley K, O’Sullivan JD. Nonpharmacological treatment, fludrocortisone, and domperidone for orthostatic hypotension in Parkinson’s disease. Mov Disord. 2007;22(11):1543–9.

    PubMed  Google Scholar 

  100. Lopes de Faria SR, Zanella MT, Andriolo A, Ribeiro AB, Chacra AR. Peripheral dopaminergic blockade for the treatment of diabetic orthostatic hypotension. Clin Pharmacol Ther. 1988;44(6):670–4.

    PubMed  CAS  Google Scholar 

  101. Montastruc JL, Chamontin B, Senard JM, Rascol A. Domperidone in the management of orthostatic hypotension. Clin Neuropharmacol. 1985;8(2):191–2.

    PubMed  CAS  Google Scholar 

  102. Lertxundi U, Peral J, Mora O, Domingo-Echaburu S, Martinez-Bengoechea MJ, Garcia-Monco JC. Antidopaminergic therapy for managing comorbidities in patients with Parkinson’s disease. Am J Health Syst Pharm. 2008;65(5):414–9.

    PubMed  Google Scholar 

  103. Rossi M, Giorgi G. Domperidone and long QT syndrome. Curr Drug Saf. 2010;5(3):257–62.

    PubMed  CAS  Google Scholar 

  104. van Noord C, Dieleman JP, van Herpen G, Verhamme K, Sturkenboom MC. Domperidone and ventricular arrhythmia or sudden cardiac death: a population-based case-control study in the Netherlands. Drug Saf. 2010;33(11):1003–14.

    PubMed  Google Scholar 

  105. Johannes CB, Varas-Lorenzo C, McQuay LJ, Midkiff KD, Fife D. Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case-control study. Pharmacoepidemiol Drug Saf. 2010;19(9):881–8.

    PubMed  Google Scholar 

  106. Schroeder C, Tank J, Boschmann M, Diedrich A, Sharma AM, Biaggioni I, et al. Selective norepinephrine reuptake inhibition as a human model of orthostatic intolerance. Circulation. 2002;105(3):347–53.

    PubMed  CAS  Google Scholar 

  107. Tank J, Schroeder C, Diedrich A, Szczech E, Haertter S, Sharma AM, et al. Selective impairment in sympathetic vasomotor control with norepinephrine transporter inhibition. Circulation. 2003;107(23):2949–54.

    PubMed  Google Scholar 

  108. Shibao C, Raj SR, Gamboa A, Diedrich A, Choi L, Black BK, et al. Norepinephrine transporter blockade with atomoxetine induces hypertension in patients with impaired autonomic function. Hypertension. 2007;50(1):47–53.

    PubMed  CAS  Google Scholar 

  109. Okamoto LE, Shibao C, Gamboa A, Choi L, Diedrich A, Raj SR, et al. Synergistic effect of norepinephrine transporter blockade and alpha-2 antagonism on blood pressure in autonomic failure. Hypertension. 2012;59(3):650–6.

    PubMed  CAS  Google Scholar 

  110. Chobanian AV, Volicer L, Tifft CP, Gavras H, Liang CS, Faxon D. Mineralocorticoid-induced hypertension in patients with orthostatic hypotension. N Engl J Med. 1979;301(2):68–73.

    PubMed  CAS  Google Scholar 

  111. Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium: fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991;83(6):1849–65.

    PubMed  CAS  Google Scholar 

  112. van Lieshout JJ, ten Harkel AD, Wieling W. Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure. Clin Auton Res. 2000;10(1):35–42.

    PubMed  Google Scholar 

  113. Norcliffe-Kaufmann L, Axelrod FB, Kaufmann H. Developmental abnormalities, blood pressure variability and renal disease in Riley Day syndrome. J Hum Hypertens. 2013;27(1):51–5.

    PubMed  CAS  Google Scholar 

  114. Biaggioni I, Robertson D, Krantz S, Jones M, Haile V. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med. 1994;121(3):181–6.

    PubMed  CAS  Google Scholar 

  115. Winkler AS, Marsden J, Parton M, Watkins PJ, Chaudhuri KR. Erythropoietin deficiency and anaemia in multiple system atrophy. Mov Disord. 2001;16(2):233–9.

    PubMed  CAS  Google Scholar 

  116. Winkler AS, Landau S, Watkins P, Chaudhuri KR. Observations on haematological and cardiovascular effects of erythropoietin treatment in multiple system atrophy with sympathetic failure. Clin Auton Res. 2002;12(3):203–6.

    PubMed  Google Scholar 

  117. Rao SV, Stamler JS. Erythropoietin, anemia, and orthostatic hypotension: the evidence mounts. Clin Auton Res. 2002;12(3):141–3.

    PubMed  Google Scholar 

  118. Hoeldtke RD, Streeten DH. Treatment of orthostatic hypotension with erythropoietin. N Engl J Med. 1993;329(9):611–5.

    PubMed  CAS  Google Scholar 

  119. Perera R, Isola L, Kaufmann H. Effect of recombinant erythropoietin on anemia and orthostatic hypotension in primary autonomic failure. Clin Auton Res. 1995;5(4):211–3.

    PubMed  CAS  Google Scholar 

  120. Winkler AS, Landau S, Watkins PJ. Erythropoietin treatment of postural hypotension in anemic type 1 diabetic patients with autonomic neuropathy: a case study of four patients. Diabetes Care. 2001;24(6):1121–3.

    PubMed  CAS  Google Scholar 

  121. Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med. 1998;339(9):584–90.

    PubMed  CAS  Google Scholar 

  122. Albillos A, Rossi I, Iborra J, Lledo JL, Calleja JL, Barrios C, et al. Octreotide prevents postprandial splanchnic hyperemia in patients with portal hypertension. J Hepatol. 1994;21(1):88–94.

    PubMed  CAS  Google Scholar 

  123. Hoeldtke RD, Bryner KD, Hoeldtke ME, Hobbs G. Treatment of autonomic neuropathy, postural tachycardia and orthostatic syncope with octreotide LAR. Clin Auton Res. 2007;17(6):334–40.

    PubMed  Google Scholar 

  124. Bordet R, Benhadjali J, Destee A, Belabbas A, Libersa C. Octreotide effects on orthostatic hypotension in patients with multiple system atrophy: a controlled study of acute administration. Clin Neuropharmacol. 1995;18(1):83–9.

    PubMed  CAS  Google Scholar 

  125. Lamarre-Cliche M, Cusson J. Octreotide for orthostatic hypotension. Can J Clin Pharmacol. 1999;6(4):213–5.

    PubMed  CAS  Google Scholar 

  126. Smith GD, Alam M, Watson LP, Mathias CJ. Effect of the somatostatin analogue, octreotide, on exercise-induced hypotension in human subjects with chronic sympathetic failure. Clin Sci (Lond). 1995;89(4):367–73.

    CAS  Google Scholar 

  127. Kaufmann H, Oribe E, Miller M, Knott P, Wiltshire-Clement M, Yahr MD. Hypotension-induced vasopressin release distinguishes between pure autonomic failure and multiple system atrophy with autonomic failure. Neurology. 1992;42(3 Pt 1):590–3.

    PubMed  CAS  Google Scholar 

  128. Ozawa T, Oyanagi K, Tanaka H, Horikawa Y, Takahashi H, Morita T, et al. Suprachiasmatic nucleus in a patient with multiple system atrophy with abnormal circadian rhythm of arginine-vasopressin secretion into plasma. J Neurol Sci. 1998;154(1):116–21.

    PubMed  CAS  Google Scholar 

  129. Manning M, Sawyer WH. Design, synthesis and some uses of receptor-specific agonists and antagonists of vasopressin and oxytocin. J Recept Res. 1993;13(1–4):195–214.

    PubMed  CAS  Google Scholar 

  130. Suchowersky O, Furtado S, Rohs G. Beneficial effect of intranasal desmopressin for nocturnal polyuria in Parkinson’s disease. Mov Disord. 1995;10(3):337–40.

    PubMed  CAS  Google Scholar 

  131. Mathias CJ, Fosbraey P, da Costa DF, Thornley A, Bannister R. The effect of desmopressin on nocturnal polyuria, overnight weight loss, and morning postural hypotension in patients with autonomic failure. Br Med J (Clin Res Ed). 1986;293(6543):353–4.

    CAS  Google Scholar 

  132. Jordan J, Shannon JR, Pohar B, Paranjape SY, Robertson D, Robertson RM, et al. Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure. J Am Soc Nephrol. 1999;10(1):35–42.

    PubMed  CAS  Google Scholar 

  133. Shibao C, Gamboa A, Abraham R, Raj SR, Diedrich A, Black B, et al. Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure. Hypertension. 2006;47(3):522–6.

    PubMed  CAS  Google Scholar 

  134. Shannon J, Jordan J, Costa F, Robertson RM, Biaggioni I. The hypertension of autonomic failure and its treatment. Hypertension. 1997;30(5):1062–7.

    PubMed  CAS  Google Scholar 

  135. Polinsky RJ, Samaras GM, Kopin IJ. Sympathetic neural prosthesis for managing orthostatic hypotension. Lancet. 1983;1(8330):901–4.

    PubMed  CAS  Google Scholar 

  136. Goldstein DS, Sewell L, Holmes C, Pechnik S, Diedrich A, Robertson D. Temporary elimination of orthostatic hypotension by norepinephrine infusion. Clin Auton Res. 2012;22(6):303–6.

    PubMed  Google Scholar 

  137. Sato T, Kawada T, Shishido T, Sugimachi M, Alexander J Jr, Sunagawa K. Novel therapeutic strategy against central baroreflex failure: a bionic baroreflex system. Circulation. 1999;100(3):299–304.

    PubMed  CAS  Google Scholar 

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Acknowledgments

HK is a member of the Scientific Advisory Board of Chelsea Therapeutics International, Ltd. and has received grant support from the National Institutes of Health, the Food and Drug Administration, and the Dysautonomia Foundation. JJ and CS have no disclosures. No funding was received for this review.

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Authors and Affiliations

  1. Institute of Clinical Pharmacology, OE 5350, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    Christoph Schroeder & Jens Jordan

  2. Dysautonomia Research Laboratory, New York University School of Medicine, New York, USA

    Horacio Kaufmann

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  1. Christoph Schroeder
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  2. Jens Jordan
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  3. Horacio Kaufmann
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Correspondence to Christoph Schroeder.

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Schroeder, C., Jordan, J. & Kaufmann, H. Management of Neurogenic Orthostatic Hypotension in Patients with Autonomic Failure. Drugs 73, 1267–1279 (2013). https://doi.org/10.1007/s40265-013-0097-0

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