Guest: Daniel Claassen, MD, MS

Neurogenic orthostatic hypotension (nOH) is a subset of orthostatic hypotension and is prevalent in patients with autonomic dysfunction.1,2 The cardinal symptoms of nOH include dizziness and lightheadedness,3 but frequently could include syncope, cognitive slowing, generalized weakness, coat-hanger (neck and shoulder) headache, fatigue, orthostatic dyspnea, blurred vision, and orthostatic angina.3 According to the Harris Poll conducted among nOH patients and their caregivers, the symptoms of nOH have a negative impact on activities of daily living. The symptoms are often minimized, poorly recognized/evaluated, or inadequately discussed and addressed.4

Patients with nOH may experience symptoms that can make daily tasks a challenge.1,5 The frequency and severity of symptomatic episodes can be unpredictable,6 and it is this unpredictability of events that contributes to a vicious cycle of nOH.1 In this cycle, fear of symptomatic events and falls may lead patients to reduce physical activity.1,5

References:

1. Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract. 2017;4(3):298-308.
2. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.
3. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624.
4. Claassen DO, Adler …