title: The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension.
abstract: Neurogenic orthostatic hypotension (nOH) is common in patients with neurodegenerative disorders such as Parkinson's disease, multiple system atrophy, pure autonomic failure, dementia with Lewy bodies, and peripheral neuropathies including amyloid or diabetic neuropathy. Due to the frequency of nOH in the aging population, clinicians need to be well informed about its diagnosis and management. To date, studies of nOH have used different outcome measures and various methods of diagnosis, thereby preventing the generation of evidence-based guidelines to direct clinicians towards 'best practices' when treating patients with nOH and associated supine hypertension. To address these issues, the American Autonomic Society and the National Parkinson Foundation initiated a project to develop a statement of recommendations beginning with a consensus panel meeting in Boston on November 7, 2015, with continued communications and contributions to the recommendations through October of 2016. This paper summarizes the panel members' discussions held during the initial meeting along with continued deliberations among the panel members and provides essential recommendations based upon best available evidence as well as expert opinion for the (1) screening, (2) diagnosis, (3) treatment of nOH, and (4) diagnosis and treatment of associated supine hypertension.
authors.affiliation: Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA. cgibbons@bidmc.harvard.edu.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Gibbons
authors.affiliation: National Parkinson Foundation, Miami, FL, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Schmidt
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Italo
authors.initials: I
authors.lastname: Biaggioni
authors.affiliation: Duke University Hospital and Central Carolina Hospital, Durham, NC, USA.
authors.forename: Camille
authors.initials: C
authors.lastname: Frazier-Mills
authors.affiliation: Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Freeman
authors.affiliation: Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Isaacson
authors.affiliation: University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Karabin
authors.affiliation: University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Kuritzky
authors.affiliation: Keck/USC School of Medicine, Los Angeles, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Lew
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Low
authors.affiliation: Saint Louis University Hospital, St. Louis, MO, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mehdirad
authors.affiliation: University of Calgary, Calgary, BC, Canada.
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Vernino
authors.affiliation: New York University Langone Medical Center, New York, NY, USA.
authors.forename: Horacio
authors.initials: H
authors.lastname: Kaufmann
mesh_terms: D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D007024:Hypotension, Orthostatic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016683:Supine Position
keywords: Autonomic dysfunction; Droxidopa; Fludrocortisone; Midodrine; Neurogenic orthostatic hypotension; Supine hypertension