Damage to the autonomic nervous system can result in a failure of blood pressure regulation.8 The autonomic nervous system, using noradrenaline signalling, would normally regulate blood pressure from dropping more than a modest amount (10 mmHg systolic blood pressure) upon standing.9-11 These sympathetic systems can become damaged in diseases such as PD and, when they are dysfunctional, this can lead to orthostatic hypotension of neurogenic cause.8,10
The symptoms of neurogenic orthostatic hypotension, as shown on the slide, vary from patient to patient, but classically include dizziness, lightheadedness, and feeling close to fainting.8
References:
1. 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.
2. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med 2008; 358 (6): 615–624.
3. Mathias CJ. L-dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension: the European experience. Clin Auton Res 2008; 18 (Suppl 1): 25–29.
4. Perlmuter LC, Sarda G, Casavant V, et al. A review of orthostatic blood pressure regulation and its association with mood and cognition. Clin Auton Res 2012; 22 (2): 99–107.
5. Sclater A, Alagiakrishnan K. Orthostatic hypotension: a primary care primer for assessment and treatment. Geriatrics 2004; 59 (8): 22–27.
6. Merola A, Romagnolo A, Rosso M, et al. Orthostatic hypotension in Parkinson’s disease: does it matter if asymptomatic? Parkinsonism Relat Disord 2016; 33: 65–71.
7. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation 2009; 119 (1): 139–146.
8. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther 2015; 13 (8): 875–891.
9. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264 (8): 1567–1582.
10. Metzler M, Duerr S, Granata R, et al. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management. J Neurol 2013; 260 (9): 2212–2219.
11. Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract 2017; 4 (3): 298–308.
