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Management of neurogenic orthostatic hypotension in the heart failure patient

  • Debra D. Dixon
    Affiliations
    Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
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  • James A.S. Muldowney III
    Correspondence
    Corresponding author at: Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, 5429 Medical Center East, South Tower, 1215 21st Avenue South, Nashville, TN 37232–8802, United States of America.
    Affiliations
    Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
    Search for articles by this author

      Highlights

      • Heart failure and neurogenic orthostatic hypotension have disparate treatment strategies.
      • Stepwise strategies are: Undoing modifying CHF treatments, using conservative measures, then adding nOH treatments

      Abstract

      Neurogenic orthostatic hypotension (nOH) is a common comorbidity in patients with neurodegenerative diseases. It is associated with an increased risk of falls, incident cardiovascular disease, and all-cause mortality. There are over 5 million individuals in the U.S. with heart failure (HF) with an associated 50% mortality rate at 5 years. The prevalence of nOH and HF increase with age and, as the population continues to age, will be increasingly common comorbid conditions. Thus, the effective management of these conditions has important implications for public health. The management of orthostatic hypotension in the context of congestive heart failure is challenging due to the fact that the fundamental principles of management of these disease states are in opposition to each other. In this review, we will discuss the principles of management of nOH and HF and outline strategies for the effective treatment of these comorbid conditions.

      Abbreviations:

      ACEi (Angiotensin converting enzyme inhibitor), ANRI (angiotensin-neprilysin inhibitor), ARB (Angiotensin receptor blockers), BB (Beta-blocker), BP (Blood pressure), HF (Heart failure), HFpEF (Heart failure with preserved ejection fraction), HFrEF (Heart failure with reduced ejection fraction), HTN (Hypertension), nOH (Neurogenic orthostatic hypotension), OH (Orthostatic hypotension)

      Keywords

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