Pitton Rissardo Jamir, Rashidi Masoumeh, Rashidi Fatemeh, Hmedat Khalil I, Khalil Ibrahim, Moharam Hania, Bahar Mallak, Dway Ali, Prathiraja Omesh, Fornari Caprara Ana Leticia, Jayasinghe Maleesha
Neurology, Cooper University Hospital, Camden, USA.
Medical School, Nanjing Medical University, Nanjing, CHN.
Cureus. 2025 Jul 22;17(7):e88487. doi: 10.7759/cureus.88487. eCollection 2025 Jul.
Neurogenic orthostatic hypotension (nOH) and classical orthostatic hypotension (OH) are prevalent non-motor manifestations of Parkinson's disease (PD). They can significantly impact quality of life, increasing the risk of falls, cognitive decline, and functional impairment. Despite the high prevalence and clinical impact of neurogenic orthostatic hypotension and OH in PD, no comprehensive consensus integrates recent advances in pathophysiology, diagnostic tools, and personalized treatment. This review synthesizes current evidence to bridge this gap, offering a practical framework for clinicians to improve patient outcomes. Neurogenic orthostatic hypotension in PD results from complex interactions between central and peripheral autonomic dysfunction, alpha-synuclein accumulation, baroreflex failure, and medication effects. Its prevalence increases with disease progression and age. Clinical evaluation remains the cornerstone of diagnosis, supported by specialized testing such as the active standing test, ambulatory blood pressure monitoring, and autonomic function assessments. Management requires a tailored approach, combining non-pharmacologic strategies, such as fluid and salt intake optimization, compression garments, and physical counter-maneuvers, with pharmacological treatments, including midodrine, droxidopa, and fludrocortisone. Emerging therapies and ongoing clinical trials offer promising avenues for future interventions. Early recognition and individualized management of OH are critical in PD care.
神经源性直立性低血压（nOH）和经典直立性低血压（OH）是帕金森病（PD）常见的非运动症状。它们会显著影响生活质量，增加跌倒、认知衰退和功能障碍的风险。尽管神经源性直立性低血压和OH在PD中患病率高且具有临床影响，但尚无全面共识整合病理生理学、诊断工具和个性化治疗方面的最新进展。本综述综合当前证据以弥合这一差距，为临床医生提供一个改善患者预后的实用框架。PD中的神经源性直立性低血压源于中枢和外周自主神经功能障碍、α-突触核蛋白积聚、压力反射衰竭及药物作用之间的复杂相互作用。其患病率随疾病进展和年龄增加而升高。临床评估仍是诊断的基石，主动站立试验、动态血压监测和自主神经功能评估等专门检测可为其提供支持。管理需要采用量身定制的方法，将非药物策略（如优化液体和盐摄入、穿加压服及进行物理对抗动作）与药物治疗（包括米多君、屈昔多巴和氟氢可的松）相结合。新兴疗法和正在进行的临床试验为未来干预提供了有前景的途径。在PD护理中，早期识别和个体化管理OH至关重要。
