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Neurogenic orthostatic hypotension in Parkinson's disease: evaluation, management, and emerging role of droxidopa.
Vasc Health Risk Manag. 2014; 10:169-76.VH

Abstract

Neurogenic orthostatic hypotension (nOH) is due to failure of the autonomic nervous system to regulate blood pressure in response to postural changes due to an inadequate release of norepinephrine, leading to orthostatic hypotension and supine hypertension. nOH is common in Parkinson's disease (PD). Prevalence varies throughout the course of PD, ranging from 40% to 60%, and resulting in symptomatic nOH in approximately half. Symptomatic nOH, including lightheadedness, can limit daily activities and lead to falls. Symptomatic nOH can also limit therapeutic options for treating PD motor symptoms. Clinical evaluation should routinely include symptom assessment and blood pressure measurement of supine, sitting, and 3-minute standing; 24-hour ambulatory blood pressure monitoring can also be helpful. Non-pharmacological management of symptomatic nOH involves education, physical maneuvers, and adequate hydration. Current pharmacological treatment of symptomatic nOH includes salt supplement, fludrocortisone, midodrine, pyridostigmine, and other empiric medications. Despite these options, treatment of symptomatic nOH remains suboptimal, often limited by severe increases in supine blood pressure. Droxidopa, an oral prodrug converted by decarboxylation to norepinephrine, is a promising therapeutic option for symptomatic nOH in PD, improving symptoms of nOH, daily activities, falls, and standing systolic blood pressure in several recent trials. These trials demonstrated short-term efficacy and tolerability, with comparable increases in standing and supine blood pressures. Longer-term studies are ongoing to confirm durability of treatment effect.

Authors+Show Affiliations

Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA.Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24729712

Citation

Isaacson, Stuart H., and Julia Skettini. "Neurogenic Orthostatic Hypotension in Parkinson's Disease: Evaluation, Management, and Emerging Role of Droxidopa." Vascular Health and Risk Management, vol. 10, 2014, pp. 169-76.
Isaacson SH, Skettini J. Neurogenic orthostatic hypotension in Parkinson's disease: evaluation, management, and emerging role of droxidopa. Vasc Health Risk Manag. 2014;10:169-76.
Isaacson, S. H., & Skettini, J. (2014). Neurogenic orthostatic hypotension in Parkinson's disease: evaluation, management, and emerging role of droxidopa. Vascular Health and Risk Management, 10, 169-76. https://doi.org/10.2147/VHRM.S53983
Isaacson SH, Skettini J. Neurogenic Orthostatic Hypotension in Parkinson's Disease: Evaluation, Management, and Emerging Role of Droxidopa. Vasc Health Risk Manag. 2014;10:169-76. PubMed PMID: 24729712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurogenic orthostatic hypotension in Parkinson's disease: evaluation, management, and emerging role of droxidopa. AU - Isaacson,Stuart H, AU - Skettini,Julia, Y1 - 2014/04/03/ PY - 2014/4/15/entrez PY - 2014/4/15/pubmed PY - 2014/9/3/medline KW - (pre)syncope KW - autonomic KW - falls KW - lightheadedness KW - norepinephrine KW - treatment SP - 169 EP - 76 JF - Vascular health and risk management JO - Vasc Health Risk Manag VL - 10 N2 - Neurogenic orthostatic hypotension (nOH) is due to failure of the autonomic nervous system to regulate blood pressure in response to postural changes due to an inadequate release of norepinephrine, leading to orthostatic hypotension and supine hypertension. nOH is common in Parkinson's disease (PD). Prevalence varies throughout the course of PD, ranging from 40% to 60%, and resulting in symptomatic nOH in approximately half. Symptomatic nOH, including lightheadedness, can limit daily activities and lead to falls. Symptomatic nOH can also limit therapeutic options for treating PD motor symptoms. Clinical evaluation should routinely include symptom assessment and blood pressure measurement of supine, sitting, and 3-minute standing; 24-hour ambulatory blood pressure monitoring can also be helpful. Non-pharmacological management of symptomatic nOH involves education, physical maneuvers, and adequate hydration. Current pharmacological treatment of symptomatic nOH includes salt supplement, fludrocortisone, midodrine, pyridostigmine, and other empiric medications. Despite these options, treatment of symptomatic nOH remains suboptimal, often limited by severe increases in supine blood pressure. Droxidopa, an oral prodrug converted by decarboxylation to norepinephrine, is a promising therapeutic option for symptomatic nOH in PD, improving symptoms of nOH, daily activities, falls, and standing systolic blood pressure in several recent trials. These trials demonstrated short-term efficacy and tolerability, with comparable increases in standing and supine blood pressures. Longer-term studies are ongoing to confirm durability of treatment effect. SN - 1178-2048 UR - https://www.unboundmedicine.com/medline/citation/24729712/Neurogenic_orthostatic_hypotension_in_Parkinson's_disease:_evaluation_management_and_emerging_role_of_droxidopa_ L2 - https://dx.doi.org/10.2147/VHRM.S53983 DB - PRIME DP - Unbound Medicine ER -