Mouat D
Geriatrics. 1978 Apr;33(4):83-93.
Simple bedside measurements of blood pressure and systolic pressure response to the Valsalva maneuver will confirm a clinical impression of orthostatic hypotension. Careful questioning of the patient usually elicits other symptoms of autonomic nervous system dysfunction, such as impotence, urinary and fecal incontinence, constipation or diarrhea, blurred vision, or sweating changes. Drugs are the most common cause of autonomic dysfunction, and their benefits should be weighed against the severity of the dysfunction. In addition, diabetes mellitus, uremia, amyloidosis, acute intermittent porphyria, myeloma, tabes dorsalis, and alcohol-nutritional problems may produce symptoms of autonomic dysfunction. Thus, patients who present with autonomic features but no history of dysfunction-producing drugs should undergo complete laboratory evaluation. A regimen of tyramine or L-dopa or a diet rich in cheese, processed meats, and wine (a monoamine), coupled with a monoamine oxidase inhibitor have beneficial effects in patients with orthostatic hypotension due to preganglionic autonomic dysfunction. Patients who do not respond to catecholamine precursors have stable, isolated orthostatic hypotension or a polyneuropathy such as that caused by diabetes.
通过简单的床边血压测量以及对瓦尔萨尔瓦动作的收缩压反应，可证实直立性低血压的临床印象。仔细询问患者通常会引出自主神经系统功能障碍的其他症状，如阳痿、大小便失禁、便秘或腹泻、视力模糊或出汗变化。药物是自主神经功能障碍最常见的原因，应权衡其益处与功能障碍的严重程度。此外，糖尿病、尿毒症、淀粉样变性、急性间歇性卟啉病、骨髓瘤、脊髓痨以及酒精 - 营养问题可能会产生自主神经功能障碍的症状。因此，出现自主神经特征但无导致功能障碍药物史的患者应接受全面的实验室评估。对于因节前自主神经功能障碍导致直立性低血压的患者，给予酪胺或左旋多巴治疗方案，或富含奶酪、加工肉类和葡萄酒（一种单胺）的饮食，再加上单胺氧化酶抑制剂，会有有益效果。对儿茶酚胺前体无反应的患者存在稳定的、孤立性直立性低血压或患有诸如糖尿病所致的多发性神经病。
