Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Semin Neurol. 2020 Oct;40(5):515-522. doi: 10.1055/s-0040-1713886. Epub 2020 Oct 14.
This review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on novel treatment strategies and new insights into the mechanism underlying these conditions. Our goal is to provide practical advice for clinicians on how to screen, diagnose, and treat these conditions with nonpharmacological and pharmacological approaches. For each disorder, we offered a stepwise recommendation on how to apply these new concepts to successfully ameliorate the symptoms associated with OH to prevent syncope and falls. The management of OH in patients who also have supine hypertension requires special considerations and pharmacotherapy. It is noteworthy that there are few therapeutic options for OH and only two Food and Drug Administration-approved drugs for the treatment of OH and nOH based on randomized clinical trials. We will use these studies to develop evidence-based guidelines for OH. The research is limited for postprandial hypotension and supine hypertension, and therefore the recommendations will be based on small studies, clinical expertise, and, above all, an understanding of the underlying pathophysiology.
这篇综述提供了治疗神经源性直立性低血压（nOH）、餐后低血压和仰卧位高血压的建议。它侧重于这些疾病的新治疗策略和机制的新见解。我们的目标是为临床医生提供实用的建议，指导他们如何通过非药物和药物方法筛查、诊断和治疗这些疾病。对于每种疾病，我们提供了一个逐步的建议，说明如何应用这些新概念来成功缓解与 OH 相关的症状，以预防晕厥和跌倒。对于同时患有仰卧位高血压的 OH 患者，管理需要特别注意和药物治疗。值得注意的是，OH 的治疗选择很少，仅有两种基于随机临床试验的 FDA 批准的治疗 OH 和 nOH 的药物。我们将使用这些研究来制定 OH 的循证指南。对于餐后低血压和仰卧位高血压的研究有限，因此建议将基于小型研究、临床专业知识，最重要的是对潜在病理生理学的理解。
