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Understanding Neurogenic Orthostatic Hypotension and the Role of Norepinephrine

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Understanding Neurogenic Orthostatic Hypotension and the Role of Norepinephrine
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View an animated exploration of the pathogenesis of nOH, as well as the mechanisms behind therapeutic approaches to controlling its effects.

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  • Overview

    Neurogenic orthostatic hypotension (nOH) is a subset of orthostatic hypotension and is prevalent in patients with autonomic dysfunction (1-3). In these patients, there is insufficient compensatory peripheral release of norepinephrine, the major neurotransmitter responsible for blood pressure maintenance, upon standing or following postural change (2,4,5). Due to this norepinephrine deficiency, there is inadequate vasoconstriction to maintain blood pressure or cerebral blood flow (1,5,6). This may lead to symptoms of nOH, which may increase the risk of falls and lead to serious consequences (7,8).

    Here, Dr. Satish Raj, Professor of Cardiac Sciences at the Libin Cardiovascular Institute at the University of Calgary’s Cumming School of Medicine and Medical Director of Calgary Autonomic Clinic, discusses the pathogenesis of nOH, as well as the mechanisms behind therapeutic approaches to controlling its effects.

    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.
    1. 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.
    2. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.  
    3. Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol. 2015;7(4):204-214.
    4. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624.
    5. Rascol O, Perez-Lloret S, Damier P, et al. Falls in ambulatory non-demented patients with Parkinson’s disease. J Neural Transm (Vienna). 2015;122(10):1447-1455.
    6. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139-146.

    © 2021 Lundbeck. All rights reserved. UBR-D-100852

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Programs 5/13/21