TY - JOUR
T1 - Neurogenic Orthostatic Hypotension in Parkinson Disease
T2 - A Primer
AU - Cutsforth-Gregory, Jeremy K.
AU - Low, Phillip A.
N1 - Funding Information:
Lundbeck (Deerfield, IL) provided funding for editorial support for manuscript preparation and for the Rapid Service Fee. This work was supported in part by the National Institutes of Health (NS 32352 Autonomic Disorders Program Project NS 44233 Pathogenesis and Diagnosis of Multiple System Atrophy, NS 92625 Multiple System Atrophy—Novel Targets in Early Diagnosis, Pathophysiology, and Therapeutic Approach, U54 NS065736 Autonomic Rare Disease Clinical Consortium), Mayo CTSA (UL1 TR000135), and Mayo Funds.
Funding Information:
Medical writing and editorial assistance in the preparation of this article was provided by Lauren Stutzbach, PhD, and Lisa Havran, PhD, of the CHC Group (North Wales, PA, USA). Support for this assistance was funded by Lundbeck.
Funding Information:
Lundbeck (Deerfield, IL) provided funding for editorial support for manuscript preparation and for the Rapid Service Fee. This work was supported in part by the National Institutes of Health (NS 32352 Autonomic Disorders Program Project NS 44233 Pathogenesis and Diagnosis of Multiple System Atrophy, NS 92625 Multiple System Atrophy?Novel Targets in Early Diagnosis, Pathophysiology, and Therapeutic Approach, U54 NS065736 Autonomic Rare Disease Clinical Consortium), Mayo CTSA (UL1 TR000135), and Mayo Funds. Medical writing and editorial assistance in the preparation of this article was provided by Lauren Stutzbach, PhD, and Lisa Havran, PhD, of the CHC Group (North Wales, PA, USA). Support for this assistance was funded by Lundbeck. All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. JK Cutsforth-Gregory and PA Low contributed to all aspects of development for this review manuscript, including conception, organization, execution, drafting, review, and critique. Both authors provided final approval of the manuscript for submission. Dr. Cutsforth-Gregory receives royalties for the textbook Mayo Clinic Medical Neurosciences. Dr. Low receives research support from the National Institutes of Health (P01 NS44233, U54 NS065736, R01 NS092625, and UL1 TR000135), US FDA (R01 FD004789), Cure MSA Foundation, and Mayo Funds; has served as a clinical editor of Autonomic Neuroscience ; and has received honoraria from Lundbeck for serving as a consultant or on advisory boards. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. 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/), 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.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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).
AB - 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).
KW - Non-motor symptoms of Parkinson disease
KW - Orthostatic hypotension
KW - Screening
KW - Supine hypertension
KW - Treatment
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U2 - 10.1007/s40120-019-00152-9
DO - 10.1007/s40120-019-00152-9
M3 - Review article
AN - SCOPUS:85071748636
SN - 2193-8253
VL - 8
SP - 307
EP - 324
JO - Neurology and Therapy
JF - Neurology and Therapy
IS - 2
ER -