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Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer

ABSTRACT: Parkinson disease (PD) is associated with a variety of motor and non-motor clinical manifestations, including cardiovascular autonomic dysfunction. Neurogenic orthostatic hypotension (nOH) is a potentially serious manifestation of cardiovascular sympathetic failure that occurs in approxima...

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Autores principales: Cutsforth-Gregory, Jeremy K., Low, Phillip A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946781/
https://www.ncbi.nlm.nih.gov/pubmed/31456212
http://dx.doi.org/10.1007/s40120-019-00152-9
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author Cutsforth-Gregory, Jeremy K.
Low, Phillip A.
author_facet Cutsforth-Gregory, Jeremy K.
Low, Phillip A.
author_sort Cutsforth-Gregory, Jeremy K.
collection PubMed
description ABSTRACT: Parkinson disease (PD) is associated with a variety of motor and non-motor clinical manifestations, including cardiovascular autonomic dysfunction. Neurogenic orthostatic hypotension (nOH) is a potentially serious manifestation of cardiovascular sympathetic failure that occurs in approximately 30% of patients with PD. Here we review the pathophysiology and effects of the condition as well as treatment considerations for patients with PD and nOH. Screening for nOH using orthostatic symptom questionnaires, orthostatic blood pressure measurements, and specialized autonomic testing is beneficial for the identification of symptomatic and asymptomatic cases because cardiac sympathetic denervation and nOH can occur even at early (premotor) stages of PD. Symptoms of nOH, such as orthostatic lightheadedness, in patients with PD, have been shown to adversely affect patient safety (with increased risk of falls) and quality of life and should prompt treatment with non-pharmacologic and, occasionally, pharmacologic measures. Patients with nOH are also at increased risk of supine hypertension, which requires balancing various management strategies. FUNDING: Lundbeck (Deerfield, IL). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40120-019-00152-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-69467812020-01-30 Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer Cutsforth-Gregory, Jeremy K. Low, Phillip A. Neurol Ther Review ABSTRACT: Parkinson disease (PD) is associated with a variety of motor and non-motor clinical manifestations, including cardiovascular autonomic dysfunction. Neurogenic orthostatic hypotension (nOH) is a potentially serious manifestation of cardiovascular sympathetic failure that occurs in approximately 30% of patients with PD. Here we review the pathophysiology and effects of the condition as well as treatment considerations for patients with PD and nOH. Screening for nOH using orthostatic symptom questionnaires, orthostatic blood pressure measurements, and specialized autonomic testing is beneficial for the identification of symptomatic and asymptomatic cases because cardiac sympathetic denervation and nOH can occur even at early (premotor) stages of PD. Symptoms of nOH, such as orthostatic lightheadedness, in patients with PD, have been shown to adversely affect patient safety (with increased risk of falls) and quality of life and should prompt treatment with non-pharmacologic and, occasionally, pharmacologic measures. Patients with nOH are also at increased risk of supine hypertension, which requires balancing various management strategies. FUNDING: Lundbeck (Deerfield, IL). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40120-019-00152-9) contains supplementary material, which is available to authorized users. Springer Healthcare 2019-08-27 /pmc/articles/PMC6946781/ /pubmed/31456212 http://dx.doi.org/10.1007/s40120-019-00152-9 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Cutsforth-Gregory, Jeremy K.
Low, Phillip A.
Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer
title Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer
title_full Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer
title_fullStr Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer
title_full_unstemmed Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer
title_short Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer
title_sort neurogenic orthostatic hypotension in parkinson disease: a primer
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946781/
https://www.ncbi.nlm.nih.gov/pubmed/31456212
http://dx.doi.org/10.1007/s40120-019-00152-9
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