This is not uncommon; but can happen in the elderly. The cause is usually autonomic failure.
These patients can have supine BP of 200 systolic and decrease to 70 systolic upon standing.
Goals of therapy are to prevent the supine HTN and decrease the drop in SBP while they are standing up.
So basically increase salt intake to decrease the hypotensive episodes, standing up slowly to mitigate the hypotensive symptoms and prevent sycope and falls, High Ted stocking and has to be high up to groin to increase venous return and increase CO and BP upon standing, crossing legs while standing for the same reason. and finally sleeping in 30-40 degree angle; avoiding warm drinks and meals : these above measures decreases renal flow and activates renin-angiotension system and mitigate hypotension upon standing.
2-Nitropaste at night and to be removed in AM may be helpful. Acytelcholinsterase inhibitors and there are thought to work through catacholamine surge(norepinephrine usually) and pressors activity and increase in BP during standing; and the advantage is that there no hypertensive sides effects.
Erythropoietin has been tried but hypertensive side effects do limit its use.
Clonidine may be helpful(case reports and series only); my personal experince it worked 2/3 patients. it increases upright BP through the postsynaptic effects on alpha 1 receptors agonist. and it decrease supine BP through the alpha2 receptors cenrtaly; the fact that these patients have discoordination between their central and peripheral nervous systems due to the autonomic failure, clonidine is able to perform both functions and actually narrows the orthostatic gap.
- ► 2019 (42)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- Nephronpower Views
- HyperKalemia Challenge
- TOPIC DISCUSSION: Residual renal function???
- AST Fellows Symposium on Transplantation Medicine
- CONSULT ROUNDS: Ranolazine and the Kidney?
- CONSULT ROUNDS: A primer on CVVHDF orders
- CLINICAL CASE 33, ANSWERS and SUMMARY
- Who gets kidney first?- the thoughts in 2011
- IN THE NEWS- E Nephrology
- Concept Map of Viruses and the diseases in the kid...
- TOPIC DISCUSSION: What causes Foamy Urine?
- ATC and NKF Abstracts 2011 are on line for viewing
- Kidney transplant and donation cancer risks
- Concept Map of HIV, Hep C and Hep B and the Kidney
- Viruses and the Kidney, a primer! ( a case based a...
- Concept Map of Viruses and the Kidney, a general m...
- CONSULT ROUNDS: Preparing For a Pheochromocytoma R...
- Kidney Transplant Recipient Infected With HIV From...
- TOPIC DISCUSSION: Contraction Alkalosis or CDMA?
- TOPIC DISCUSSION: Lactate levels and B2 agonists? ...
- CONSULT ROUNDS: Cefepime Neuro-toxicity and the Ne...
- More Pediatric Grand Rounds from www.pediatric-nep...
- Olmesartan for Patients with Diabetes
- ASN Review course 2011
- Hematuria Post Kidney Transplantation
- Notes from Dr. RW: Hyponatremia update
- Paraproteins and the Kidney
- Concept Map of Hypernatremia
- TOPIC DISCUSSION: TB and the Kidney
- Virtual Library ( the Welch Library) Part 2
- IN THE NEWS: Belimumab and Lupus
- Top Ten Reasons to Love you Kidneys
- Virtual Library ( the Welch Library) Part 1
- Elimination of anti rejection medicaitons
- Smoldering vs Active Myeloma
- Tissue Engineering Renal Tissue
- Concept Map of Hyponatremia
- Concept Map of BK Nephritis Treatment
- Bortezomib for desensitization!
- JOURNAL CLUB: FHN Trial
- Complications of Peritoneal Dialysis
- TOPIC DISCUSSION: Amyloidosis and Factor X deficiency
- CLINICAL CASE 34, ANSWER AND SUMMARY
- IN THE NEWS--> DOSE TRIAL
- ANCA VASCULITIS
- CONSULT ROUNDS: An approach to orthostatic hypoten...
- In the News: Transplant rules changing
- Concept Map of Kidney Injury in hematopoietic Stem...
- Growing Kidneys
- ▼ March (49)
- ► 2010 (461)