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Table of contents
Orthostatic hypotension
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of orthostatic hypotension are prepared by our editorial team based on guidelines from the International Liaison Committee on Resuscitation (ILCOR 2019), the American Heart Association (AHA/HRS/ACC 2017), and the European Federation of Neurological Societies (EFNS 2006). ...
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Diagnostic investigations
Initial evaluation
As per EFNS 2006 guidelines:
Obtain the following as part of the initial evaluation of patients with suspected OH:
structured history taking
detailed physical examination
supine and upright BP measurements
12-lead ECG recording
active standing or head-up tilt, ideally with continuous assessment of BP and HR for 3 min
B
Obtain further autonomic nervous system screening tests, with other appropriate investigations, depending on the possible etiology of the underlying disorder.
B
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Head-up tilt testing
Medical management
Fludrocortisone
As per EFNS 2006 guidelines:
Administer fludrocortisone as first line drug-monotherapy of OH.
B
Advise patients to maintain a high dietary salt and adequate fluid intake to obtain full benefits from fludrocortisone treatment.
B
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Midodrine
Droxidopa
Octreotide
Nonpharmacologic interventions
Therapeutic procedures
Physical counterpressure maneuvers
As per ILCOR 2019 guidelines:
Advise the use of any type of physical counterpressure maneuvers by individuals with acute symptoms of presyncope from vasovagal or orthostatic causes in the first aid setting.
B
Recognize that we suggest that lower-body physical counterpressure maneuvers such as leg crossing and tensing or squatting are preferable to upper-body and abdominal physical counterpressure maneuvers.
B