Orthostatic Hypotension: JACC State-of-the-Art Review

J Am Coll Cardiol. 2018 Sep 11;72(11):1294-1309. doi: 10.1016/j.jacc.2018.05.079.


Neurogenic orthostatic hypotension is a highly prevalent and disabling feature of autonomic failure due to both peripheral and central neurodegenerative diseases. Community-based epidemiological studies have demonstrated a high morbidity and mortality associated with neurogenic orthostatic hypotension. It is due to impairment of baroreflex-mediated vasoconstriction of the skeletal muscle and splanchnic circulation and is caused by damage or dysfunction at central and/or peripheral sites in the baroreflex efferent pathway. Nonpharmacological and pharmacological interventions may be implemented to ameliorate the symptoms of orthostatic intolerance and improve quality of life. Many patients will be adequately treated by education, counseling, removal of hypotensive medications, and other nonpharmacological interventions, whereas more severely afflicted patients require pharmacological interventions. The first stage of pharmacological treatment involves repletion of central blood volume. If unsuccessful, this should be followed by treatment with sympathomimetic agents.

Keywords: Parkinson disease; autonomic; baroreflex; blood pressure; diabetic neuropathies; sympathetic.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Autonomic Nervous System Diseases / diagnosis
  • Autonomic Nervous System Diseases / physiopathology
  • Baroreflex / physiology
  • Blood Volume / physiology
  • Humans
  • Hypotension, Orthostatic / diagnosis
  • Hypotension, Orthostatic / physiopathology*
  • Hypotension, Orthostatic / therapy*
  • Lewy Body Disease / diagnosis
  • Lewy Body Disease / physiopathology
  • Multiple System Atrophy / diagnosis
  • Multiple System Atrophy / physiopathology
  • Parkinson Disease / diagnosis
  • Parkinson Disease / physiopathology
  • Patient Education as Topic
  • Pure Autonomic Failure / diagnosis
  • Pure Autonomic Failure / physiopathology
  • Vasoconstriction / physiology