Sandbox:tables: Difference between revisions
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===Initial Therapy=== | ===Initial Therapy=== | ||
Preferred regimen (1): | *Preferred regimen (1): Fludrocortisone acetate at a dose of 0.1 mg per day, administered in the morning, which can eventually be increased up to 0.3 mg per day. | ||
**Considered first-line regimen for hypotension in the absence of [[heart failure]] and [[supine hypertension]] | |||
*Preferred regimen (2): Midodrine 2.5 to 10 mg three times a day. | |||
**Max dose should not exceed 40 mg/day. | |||
*Preferred regimen (2): Droxidopa starts at 100 mg and escalates to 600 mg three times per day. | |||
**Patients should not take droxidopa within four to five hours of bedtime in order to limit supine hypertension. | |||
===Secondline Therapy=== | |||
===Second line therpay==== | ===Second line therpay==== |
Revision as of 02:27, 16 August 2020
Non-Pharmacological methods | Mechanism of alleviating hypotension | Recommendations |
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Elastic stockings |
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Physical Maneuvers |
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Head up tilt sleeping |
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Intravascular volume |
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Intake of cold water |
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Drop of systolic BP > 20 mmHg (30 for hypertensive patients) | |||||||||||||||||||||||||||||||||||||||||||||||||
Symptomatic | Asymptomatic | ||||||||||||||||||||||||||||||||||||||||||||||||
Non-pharmacological treatment | Observation and follow-up | ||||||||||||||||||||||||||||||||||||||||||||||||
Persistance of symtoms | |||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacological Treatment | |||||||||||||||||||||||||||||||||||||||||||||||||
No supine hypertension or chronic heart failure | Supine hypertension or chronic heart failure: | ||||||||||||||||||||||||||||||||||||||||||||||||
Fludrocortisone Midodrine | Midodrine | ||||||||||||||||||||||||||||||||||||||||||||||||
Stepwise approach
Steps to approach a patient | |||||||||||||||||||||||||||||||||||
When we should suspect orthostatic hypotension? Unexplained fall/syncope Typical symptoms Patient history Current pharmacological treatment | |||||||||||||||||||||||||||||||||||
Initial assessment (outpatient clinic. ED and hospital): Physical examination Laboratory assessment | |||||||||||||||||||||||||||||||||||
Initial Therapy
- Preferred regimen (1): Fludrocortisone acetate at a dose of 0.1 mg per day, administered in the morning, which can eventually be increased up to 0.3 mg per day.
- Considered first-line regimen for hypotension in the absence of heart failure and supine hypertension
- Preferred regimen (2): Midodrine 2.5 to 10 mg three times a day.
- Max dose should not exceed 40 mg/day.
- Preferred regimen (2): Droxidopa starts at 100 mg and escalates to 600 mg three times per day.
- Patients should not take droxidopa within four to five hours of bedtime in order to limit supine hypertension.