Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- tontura postural, síncope e outros sintomas de hipoperfusão cerebral
Outros fatores diagnósticos
- características parkinsonianas
- ataxia cerebelar
- perda de peso
- taquicardia em repouso ou diminuição da variação da frequência cardíaca
- motilidade gastrointestinal anormal
- disfunção erétil e ausência de ejaculação
- anidrose, intolerância ao calor, pele seca ou hiperidrose focal
- polaciúria, urgência, noctúria
Fatores de risco
- idade avançada
- fragilidade e falta de condicionamento físico
- uso de medicamentos que afetam o tônus simpático
- depleção de volume/anemia
- neuropatia autonômica (por exemplo, diabetes mellitus)
- Doença de Parkinson
- demência com corpos de Lewy
- atrofia de múltiplos sistemas
- hipertensão
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- teste postural
Investigações a serem consideradas
- teste da mesa inclinável
- noradrenalina plasmática
- respiração profunda
- manobra de Valsalva
- estudos de condução nervosa e eletromiografia (EMG)
- teste quantitativo do reflexo axonal sudomotor (QSART)
- variabilidade da frequência cardíaca
- monitoração da pressão arterial de 24 horas
- anticorpos autoimunes
- tomografia computadorizada (TC) do tórax
- eletroforese de proteínas séricas e urinárias
- biópsia do coxim adiposo
- teste genético
Algoritmo de tratamento
todos os pacientes
Colaboradores
Autores
Italo Biaggioni, MD
Professor of Medicine and Pharmacology
Vanderbilt University
Nashville
TN
Declarações
IB is a consultant for Theravance Biopharma, Amneal Pharmaceuticals, Regeneron Pharmaceuticals, Takeda Pharmaceuticals, and Neurawell Therapeutics for development of therapies for orthostatic hypotension and postural tachycardia syndrome. He is also a patent holder for an automated abdominal binder for the treatment of orthostatic hypotension and has submitted a patent application for the use of guanfacine for the treatment of postural tachycardia and chronic fatigue syndromes.
Lucy Norcliffe-Kaufmann, PhD
Assistant Professor
Dysautonomia Center
Department of Physiology and Neuroscience
NYU Langone Medical Center
New York
NY
Declarações
LNK is a board member of the American Autonomic Society and has received grant support from Theravance Biopharma, PTC Therapeutics, National Institutes of Health, Michael J. Fox Foundation, and the Familial Dysautonomia Foundation. LNK is an author of a number of references cited in this topic.
Horacio Kaufmann, MD
Professor of Neurology
Medicine and Pediatrics
New York University School of Medicine
New York
NY
Declarações
HK is editor in chief of Clinical Autonomic Research and serves as principal investigator of a clinical trial sponsored by Biogen MA Inc. HK has received consultancy fees from Lilly USA LLC, Biohaven Pharmaceuticals Inc, Takeda Pharmaceutical Company Ltd, Ono Pharma UK Ltd, Lundbeck LLC, and Theravance Biopharma US Inc. HK is an author of a number of references cited in this topic.
Revisores
Phillip A. Low, MD
Robert D. and Patricia E. Kern Professor of Neurology
Mayo Clinic College of Medicine
Rochester
MN
Declarações
PAL is an author of a reference cited in this topic.
William P. Cheshire, MD
Professor of Neurology
Mayo Clinic
Jacksonville
FL
Declarações
WPC declares that he has no competing interests.
Alan Moore, MB, FRCPI
Consultant Geriatrician
Beaumont Hospital
Dublin
Ireland
Disclosures
AM has received payment from Shire Pharmaceuticals, manufacturer of midodrine, for providing educational talks, and the department in which he works has received unrestricted educational grants from Shire Pharmaceuticals.
References
Key articles
Juraschek SP, Cortez MM, Flack JM, et al. Orthostatic hypotension in adults with hypertension: a scientific statement from the American Heart Association. Hypertension. 2024 Mar;81(3):e16-30.Full text Abstract
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 Aug;264(8):1567-82.Full text Abstract
Lahrmann H, Cortelli P, Hilz M, et al. EFNS guidelines on orthostatic hypotension. In: Gilhus NE, Barnes MP, Brainin M (eds). European Handbook of Neurological Management. Vol 1, 2nd ed. Oxford: Wiley-Blackwell; 2011.
Shibao C, Lipsitz LA, Biaggioni I; American Society of Hypertension Writing Group. Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens. 2013 Jul-Aug;7(4):317-24.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Síncope neuromediada (vasovagal) ou reflexa
- Vertigem
- Quedas inespecíficas em idosos
More DifferentialsGuidelines
- Consensus statement on the definition of neurogenic supine hypertension
- Guidelines on the diagnosis and management of syncope
More GuidelinesPatient information
Hipotensão postural (pressão arterial baixa ao ficar em pé)
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