What Is Neurogenic Orthostatic Hypotension?

What Is Neurogenic Orthostatic Hypotension?

Nervous orthostatic hypotension (nOH) is a condition in which an independent system that controls automatic body functions loses when a person sits or lays down to stand up or when a person changes position quickly to regulate blood pressure. As a result, the blood pressure of nOH patients can drop suddenly and seriously.

Doctors define nOH as – Within 3 minutes of standing, systolic blood pressure drops> 20 mm Hg – high blood pressure – diastolic hypotension > 10 mm Hg – hypotension – sitting or lying down. Other daily activities that raise blood pressure, such as digesting food, lifting heavy things, and defecating, can also cause sodium hydroxide attacks.

The main symptoms of nOH include dizziness and visual impairment. Fatigue, cognitive impairment, blurred vision and shortness of breath are also part of the situation. More or more severe symptoms may occur early in the morning, hot weather, after eating a large meal, or after standing for a long time. Nervous orthostatic hypotension (nOH) is common in MSA and affects about 75% of patients. In contrast, up to 58% of Parkinson’s patients and 10% to 30% of the elderly suffer from orthostatic hypotension during orthostatic hypotension.(1)

Management Of Neurogenic Orthostatic Hypotension

Lifestyle Changes: Many non-pharmacological methods may help prevent or control body symptoms. Patients with NOH may find lifestyle changes, such as moving slower than they used to, moving more carefully to prevent rapid site changes, eating fewer meals, and avoiding extreme temperatures, such as changing from room air conditioning to the outdoor environment in the air Outdoor.

When symptoms of Nervous orthostatic hypotension (nOH) are more pronounced, rescheduling activity to the afternoon rather than in the morning may result in fewer seizures of Nervous orthostatic hypotension (nOH). Also, avoid lifting heavy objects.

Compression Stockings: It prevents the accumulation of blood in the legs while standing up prevents the blood pressure from falling. Compression stockings and other compression garments provide a mechanical impulse to make up for the lack of independent control in this case.

The commercially designed, gradient compressed commercial socks, called Jobst Socks, have higher ankles pressure and gradually reduce pressure near the top of the thighs, and some compression garments, including the abdomen, prevent dizziness or fainting The side was also performing well, known as the pre-fainting condition. These clothes have the added advantage of not blowing them.

Adequate Water Intake: Drinking water to increase blood pressure by increasing blood volume is a particularly effective method for managing Nervous orthostatic hypotension (nOH). Preventive drinking may raise your blood pressure beyond what your pharmacy can achieve. Within 20 minutes of rapid drinking of 480 ml or about 16 fluid ounces, an increase in systolic blood pressure of more than 40 mm Hg was observed.

It should be noted that purified water appears to be a major component of this approach in patients with (Multiple System Atrophy) MSA compared to other aqueous fluids. In trials using pure broth instead of water, the results were not satisfactory for MSA participants who performed a tilt test after eating 450 ml of transparent soup. Likewise, sugary drinks have the opposite effect, as they can lower blood pressure instead of raising blood pressure.

Kidney Functions And Concentration Of Salts: Eating a diet rich in salt is an effective way to raise blood pressure. If there is no history of kidney disease, it is recommended for patients with insufficiency. Before adjusting your food, consult the physician.

Nervous orthostatic hypotension can impair kidney function, making Nervous orthostatic hypotension (nOH) always sleep or lie down. In this case, blood flow from the lower body increases, which causes the kidneys to clear the blood at a higher rate.

As the number of filtered blood increases, the kidneys secrete sodium, which promotes water loss, which leads to a decrease in blood volume and further worsening of the body’s symptoms.

Bed Positioning: Raising the head of a bed from 10 to 30 degrees during sleep can increase blood pressure while standing and help compensate for the Nervous orthostatic hypotension (nOH) hypotensive effects. Patients may need to be examined regularly for several weeks before they can see significant benefits.

Crossed Legs: Crossing the legs reduces blood circulation in the legs, which helps to maintain high blood volume and thus blood pressure in the head. A study found that patients with pure involuntary nerve failure or MSA who stood by increased their mean arterial blood pressure across their legs by 24% while standing. The risk of shrinking legs while using the cross-legged method and the muscles in the hips and abdomen can help maintain blood flow to the legs while still increasing blood flow to the head.

Drug Reduction: Dopamine drugs for Parkinson’s disease and high blood pressure medications may worsen orthostatic hypotension symptoms and may require patients to reduce or stop these medications to effectively manage OH.(2, 3, 4, 5)

References:

  1. Freeman R, Abuzinadah AR, Gibbons C, Jones P, Miglis MG, Sinn DI. Orthostatic hypotension: JACC state-of-the-art review. Journal of the American College of Cardiology. 2018;72(11):1294-1309.
  2. Menant JC, Wong AK, Trollor JN, Close JC, Lord SR. Depressive symptoms and orthostatic hypotension are risk factors for unexplained falls in community‐living older people. Journal of the American Geriatrics Society. 2016;64(5):1073-1078.
  3. Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Movement disorders clinical practice. 2017;4(3):298-308.
  4. Arnold AC, Raj SR. Orthostatic hypotension: a practical approach to investigation and management. Canadian Journal of Cardiology. 2017;33(12):1725-1728.
  5. Hewitt LA, Adler CH, Claassen DO, Gibbons CH, Raj SR. Management and Treatment of Neurogenic Orthostatic Hypotension: Results From a Survey of Patients and Caregivers (P2. 130). AAN Enterprises; 2018.

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