Parkinson Disease and Orthostatic Hypotension in the Elderly: Recognition and Management of Risk Factors for Falls

LeWitt Peter A, Kymes Steve, Hauser Robert A

Table 1 Causes of OH and nOH [24-26].

Cause OH nOH Medications •Dopaminergic agents •Antidepressants (tricyclic antidepressants) •Anticholinergics •Antihypertensives •Diuretics •Nitrates •Phosphodiesterase inhibitors •Vasodilators •Negative inotropic/chronotropic agents •Central sympatholytics •Renin-angiotensin system antagonists •nOH may be exacerbated by medications that cause OH Clinical etiologies •Hypovolemia  ◦Dehydration  ◦Bleeding •Impaired cardiac output/cardiac pump failure  ◦Cardiac arrhythmia  ◦Aortic stenosis  ◦Heart failure •Venous pooling  ◦Prolonged recumbency or standing  ◦Postprandial dilation of splanchnic vessel beds  ◦Heat exposure  ◦Fever •Primary neurogenic causes  ◦Sympathetic noradrenergic denervation   ■Parkinson disease   ■Pure autonomic failure  ◦Intact sympathetic noradrenergic innervation   ■Multiple system atrophy   ■Dopamine beta-hydroxylase deficiency (intact innervation but norepinephrine deficiency) •Secondary neurogenic causes  ◦Peripheral neuropathies  ◦Spinal cord problems