Neurogenic orthostatic hypotension (nOH) is a sustained fall in blood pressure upon standing that frequently affects patients with neurodegenerative diseases (e.g., Parkinson disease) and manifests with symptoms such as lightheadedness and dizziness upon standing. nOH can severely affect patients by increasing the risk of falls and injuries and by decreasing functionality, independence, and quality of life. However, the condition is often under-recognized because of many factors, including the nonspecific nature of the symptoms, patient comorbidities, and patients' reluctance to discuss their symptoms with their healthcare providers. Increased awareness of the burden of nOH and recognition of potential barriers to efficient diagnosis may lead to improved clinical outcomes and better quality of life for patients. To better understand the manifestations and real-life impact of living with nOH symptoms, perspectives from a patient with nOH and his caregiver (wife) are provided, along with key findings from a published survey of patients and caregivers on the burden of nOH. In addition, insights and advice on a practical approach for diagnosing, educating, and treating patients with nOH are outlined.
Keywords: Caregiver; Healthcare providers; Neurogenic orthostatic hypotension; Parkinson disease; Patient perspective; Quality of life; Symptom burden.
This article discusses what neurogenic orthostatic hypotension (nOH) is, its symptoms, and how patients and healthcare providers (HCPs) can work together to manage nOH symptoms. What is nOH? People with neurologic disorders, like Parkinson disease, may also have a separate condition called nOH. nOH occurs when blood pressure drops too much when standing up after sitting or lying down. What are the symptoms of nOH, and how can they affect people’s lives? Most often, people with nOH report feeling lightheaded, faint, or dizzy when standing up. Other symptoms of nOH include pain in the shoulders and neck, trouble thinking clearly, tiredness, or blurry vision. The symptoms of nOH can cause falls and injuries. Because of nOH symptoms, people may be unable to do daily activities and may feel worried or anxious. What do patients and HCPs need to know when discussing nOH symptoms? A survey showed that patients may not talk about their nOH symptoms with their HCPs unless symptoms are severe, and that patients can find receiving a diagnosis of nOH challenging. Patients can track nOH symptoms in a daily journal to use in discussions with their HCPs. How can HCPs help patients with nOH? HCPs can ask patients with underlying neurologic disorders about symptoms that occur on standing and confirm a diagnosis of nOH by comparing the patient’s blood pressures measured lying down and after standing up. HCPs can provide information about lifestyle changes and medications that are available to manage nOH symptoms.