Diagnosis and treatment of orthostatic hypotension in Parkinson's disease
Abstract: Orthostatic hypotension (OH) is a frequent comorbidity affecting between 23 and 38% of Parkinson’s disease (PD) patients. Several pieces of evidence suggest that OH is related to faster cognitive decline and more frequent falls, and has been also connected to increased mortality. OH can be arbitrarily defined as a drop of systolic and/or diastolic blood pressure of 20 or 10 mmHg or more in the first three minutes after passing from decubitus to an upright position. Till test appears to be the most reliable tool for assessing the orthostatic response. On the other hand, the standing test and evaluation of orthostatic symptoms should be regarded as screening tests. The key physiopathological aspect of OH is an altered baroreflex function resulting from cardiac and vascular sympathetic denervation. Nonetheless, OH can be aggravated by heat, alcohol consumption or by drug treatments, such as antihypertensives, dopamine agonists or amantadine. Treatment should begin with re‐considering drug treatments. After treatment is optimized, nonpharmacological measures may be employed. Drugs treatment should be reserved for patients in whom other strategies have failed. Midodrine and fludrocortisone are the most frequently used treatments, even though evidence about their efficacy and safety is weak. Midodrine has a shorter duration of action and thus avoidance of evening dosing may help keep nocturnal blood pressure dipping intact. Promising alternatives may include droxidopa and fipamezole
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InTech
2013
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Subjects: | ENFERMEDADES NEUROGENERATIVAS, ENFERMEDAD DE PARKINSON, TRATAMIENTO, HIPOTENSION ORTOSTATICA, |
Online Access: | https://repositorio.uca.edu.ar/handle/123456789/1640 |
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oai:ucacris:123456789-16402020-08-06T23:12:29Z Diagnosis and treatment of orthostatic hypotension in Parkinson's disease Pérez Lloret, Santiago Rey, Verónica Pavy-Le Traon, Anne Rascol, Olivier ENFERMEDADES NEUROGENERATIVAS ENFERMEDAD DE PARKINSON TRATAMIENTO HIPOTENSION ORTOSTATICA Abstract: Orthostatic hypotension (OH) is a frequent comorbidity affecting between 23 and 38% of Parkinson’s disease (PD) patients. Several pieces of evidence suggest that OH is related to faster cognitive decline and more frequent falls, and has been also connected to increased mortality. OH can be arbitrarily defined as a drop of systolic and/or diastolic blood pressure of 20 or 10 mmHg or more in the first three minutes after passing from decubitus to an upright position. Till test appears to be the most reliable tool for assessing the orthostatic response. On the other hand, the standing test and evaluation of orthostatic symptoms should be regarded as screening tests. The key physiopathological aspect of OH is an altered baroreflex function resulting from cardiac and vascular sympathetic denervation. Nonetheless, OH can be aggravated by heat, alcohol consumption or by drug treatments, such as antihypertensives, dopamine agonists or amantadine. Treatment should begin with re‐considering drug treatments. After treatment is optimized, nonpharmacological measures may be employed. Drugs treatment should be reserved for patients in whom other strategies have failed. Midodrine and fludrocortisone are the most frequently used treatments, even though evidence about their efficacy and safety is weak. Midodrine has a shorter duration of action and thus avoidance of evening dosing may help keep nocturnal blood pressure dipping intact. Promising alternatives may include droxidopa and fipamezole 2019-05-02T14:01:14Z 2019-05-02T14:01:14Z 2013 Artículo Pérez Lloret, S., Rey M.V., Pavy-Le Traon, A., Rascol, O. Diagnosis and treatment of orthostatic hypotension in Parkinson's disease [en línea]. International Journal of Integrative Medicine. 2013, 1 (27). doi: 10.5772/56924. Disponible en: https://repositorio.uca.edu.ar/handle/123456789/1640 1848-8846 https://repositorio.uca.edu.ar/handle/123456789/1640 10.5772/56924 eng eng Acceso Abierto https://creativecommons.org/licenses/by-nc-sa/4.0/ application/pdf InTech Journal of Integrative Medicine, Vol. 1, Nro. 27, 2013 |
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ENFERMEDADES NEUROGENERATIVAS ENFERMEDAD DE PARKINSON TRATAMIENTO HIPOTENSION ORTOSTATICA ENFERMEDADES NEUROGENERATIVAS ENFERMEDAD DE PARKINSON TRATAMIENTO HIPOTENSION ORTOSTATICA |
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ENFERMEDADES NEUROGENERATIVAS ENFERMEDAD DE PARKINSON TRATAMIENTO HIPOTENSION ORTOSTATICA ENFERMEDADES NEUROGENERATIVAS ENFERMEDAD DE PARKINSON TRATAMIENTO HIPOTENSION ORTOSTATICA Pérez Lloret, Santiago Rey, Verónica Pavy-Le Traon, Anne Rascol, Olivier Diagnosis and treatment of orthostatic hypotension in Parkinson's disease |
description |
Abstract: Orthostatic hypotension (OH) is a frequent comorbidity affecting between 23 and 38% of Parkinson’s disease (PD) patients. Several pieces of evidence suggest that OH is related to faster cognitive decline and more frequent falls, and has been also connected to increased mortality. OH can be arbitrarily defined as a drop of systolic and/or diastolic blood pressure of 20 or 10 mmHg or more in the first three minutes after passing from decubitus to an upright position. Till test appears to be the most reliable tool for assessing the orthostatic response. On the other hand, the standing test and evaluation of orthostatic symptoms should be regarded as screening tests. The key physiopathological aspect of OH is an altered baroreflex function resulting from cardiac and vascular sympathetic denervation. Nonetheless, OH can be aggravated by heat, alcohol consumption or by drug treatments, such as antihypertensives, dopamine agonists or amantadine. Treatment should begin with re‐considering drug treatments. After treatment is optimized, nonpharmacological measures may be employed. Drugs treatment should be reserved for patients in whom other strategies have failed. Midodrine and fludrocortisone are the most frequently used treatments, even though evidence about their efficacy and safety is weak. Midodrine has a shorter duration of action and thus avoidance of evening dosing may help keep nocturnal blood pressure dipping intact. Promising alternatives may include droxidopa and fipamezole |
format |
Artículo |
topic_facet |
ENFERMEDADES NEUROGENERATIVAS ENFERMEDAD DE PARKINSON TRATAMIENTO HIPOTENSION ORTOSTATICA |
author |
Pérez Lloret, Santiago Rey, Verónica Pavy-Le Traon, Anne Rascol, Olivier |
author_facet |
Pérez Lloret, Santiago Rey, Verónica Pavy-Le Traon, Anne Rascol, Olivier |
author_sort |
Pérez Lloret, Santiago |
title |
Diagnosis and treatment of orthostatic hypotension in Parkinson's disease |
title_short |
Diagnosis and treatment of orthostatic hypotension in Parkinson's disease |
title_full |
Diagnosis and treatment of orthostatic hypotension in Parkinson's disease |
title_fullStr |
Diagnosis and treatment of orthostatic hypotension in Parkinson's disease |
title_full_unstemmed |
Diagnosis and treatment of orthostatic hypotension in Parkinson's disease |
title_sort |
diagnosis and treatment of orthostatic hypotension in parkinson's disease |
publisher |
InTech |
publishDate |
2013 |
url |
https://repositorio.uca.edu.ar/handle/123456789/1640 |
work_keys_str_mv |
AT perezlloretsantiago diagnosisandtreatmentoforthostatichypotensioninparkinsonsdisease AT reyveronica diagnosisandtreatmentoforthostatichypotensioninparkinsonsdisease AT pavyletraonanne diagnosisandtreatmentoforthostatichypotensioninparkinsonsdisease AT rascololivier diagnosisandtreatmentoforthostatichypotensioninparkinsonsdisease |
_version_ |
1756275064674713600 |