systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.26442/2075-082X_2018.2.32-42systhiper-543Research ArticleСТАТЬИARTICLESСовременные представления о диагностике и лечении ортостатической гипотензииState of the art for diagnosis and treatment of orthostatic hypotensionАксеноваА. В.AksenovaA. V.aksenovaannav@gmail.comГориеваШ. Б.GorievaSh. B.noemail@neicon.ruРогозаА. Н.RogozaA. N.noemail@neicon.ruСиваковаО. А.SivakovaO. A.noemail@neicon.ruЕсауловаТ. Е.EsaulovaT. E.noemail@neicon.ruЧазоваИ. Е.ChazovaI. E.noemail@neicon.ruФГБУ «НМИЦ кардиологии»РоссияNational Medical Research Center of Cardiologyof the Ministry of Health of the Russian FederationRussian Federation2018231220221523242Copyright © Аксенова А.В., Гориева Ш.Б., Рогоза А.Н., Сивакова О.А., Есаулова Т.Е., Чазова И.Е., 20222022Аксенова А.В., Гориева Ш.Б., Рогоза А.Н., Сивакова О.А., Есаулова Т.Е., Чазова И.Е.Aksenova A.V., Gorieva S.B., Rogoza A.N., Sivakova O.A., Esaulova T.E., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/543

В настоящем документе продемонстрированы современные представления о состоянии проблемы диагностики и лечения ортостатической гипотензии (ОГ). В нем основное внимание уделяется разработанным алгоритмам диагностики классической ОГ, начальной ОГ и отсроченной ОГ. Описаны необходимые методы для поэтапного проведения дифференциальной диагностики причин ОГ. Проанализированы рекомендации по лечению данного состояния Американской коллегии кардиологов/Американской ассоциации сердца/Общества сердечного ритма и Европейского общества кардиологов. Описаны варианты лечения различных групп пациентов с ОГ.

This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described.

ортостатическая гипотензияначальная ортостатическая гипотензияотсроченная ортостатическая гипотензиялечение ортостатической гипотензииorthostatic hypotensioninitial orthostatic hypotensiondelayed orthostatic hypotensiontreatment of orthostatic hypotensionReferencesShibao C, Lipsitz L.A, Biaggioni I. ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension. J Clin Hypertens 2013; 15 (3): 147-53.Shibao C, Lipsitz L.A, Biaggioni I. ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension. J Clin Hypertens 2013; 15 (3): 147-53.Gibbons С.H, 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; 264: 1567-82.Gibbons С.H, 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; 264: 1567-82.Amy C. Arnold, Satish R. Raj. Orthostatic hypotension - a practical approach to investigation and management. Canad J Cardiol 2017.Amy C. Arnold, Satish R. Raj. Orthostatic hypotension - a practical approach to investigation and management. Canad J Cardiol 2017.The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996; 46: 1470.The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996; 46: 1470.Freeman R, Wieling W, Axelrod F.B et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69-72.Freeman R, Wieling W, Axelrod F.B et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69-72.Brignole M, Moya A, de Lange F.J et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018. https://doi.org/10.1093/eurheartj/ehy037Brignole M, Moya A, de Lange F.J et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018. https://doi.org/10.1093/eurheartj/ehy037Benvenuto L.J, Krakoff L.R. Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens 2011; 24: 135-44.Benvenuto L.J, Krakoff L.R. Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens 2011; 24: 135-44.Low A. Prevalence of orthostatic hypotension. Clin Auton Res 2008; 18 (Suppl. 1): 8-13.Low A. Prevalence of orthostatic hypotension. Clin Auton Res 2008; 18 (Suppl. 1): 8-13.Masaki K.H, Schatz I.J, Burchfiel C.M et al. Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation 1998; 98: 2290-5.Masaki K.H, Schatz I.J, Burchfiel C.M et al. Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation 1998; 98: 2290-5.Rutan G.H, Hermanson R, Bild D.E et al. Orthostatic hypotension in older adults. The cardiovascular health study. CHS Collaborative Research Group. Hypertension 1992; 19 (6 Pt. 1): 508-19.Rutan G.H, Hermanson R, Bild D.E et al. Orthostatic hypotension in older adults. The cardiovascular health study. CHS Collaborative Research Group. Hypertension 1992; 19 (6 Pt. 1): 508-19.Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing 2010; 39: 51-6.Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing 2010; 39: 51-6.Poon I.O, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005; 30: 173-8.Poon I.O, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005; 30: 173-8.Xin W, Mi S, Lin Z et al. Orthostatic hypotension and the risk of incidental cardiovascular diseases: A meta-analysis of prospective cohort studies. Preventive Med 2016; 85: 90-7 DOI: 10.1016/j.ypmed.2016.01.007Xin W, Mi S, Lin Z et al. Orthostatic hypotension and the risk of incidental cardiovascular diseases: A meta-analysis of prospective cohort studies. Preventive Med 2016; 85: 90-7 DOI: 10.1016/j.ypmed.2016.01.007Ooi W.L, Hossain M, Lipsitz L.A. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108: 106-11.Ooi W.L, Hossain M, Lipsitz L.A. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108: 106-11.Rubenstein L.Z. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35 (Suppl. 2): ii37-ii41.Rubenstein L.Z. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35 (Suppl. 2): ii37-ii41.Jonsson P.V, Lipsitz L.A, Kelley M, Koestner J. Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls. Arch Int Med 1990; 150: 1518-24.Jonsson P.V, Lipsitz L.A, Kelley M, Koestner J. Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls. Arch Int Med 1990; 150: 1518-24.Sarasin F.P, Louis-Simonet M, Carballo D et al. Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Am J Emerg Med 2002; 20: 497-501.Sarasin F.P, Louis-Simonet M, Carballo D et al. Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Am J Emerg Med 2002; 20: 497-501.Atkins D, Hanusa B, Sefcik T, Kapoor W. Syncope and orthostatic hypotension. Am J Med 1991; 91: 179-85.Atkins D, Hanusa B, Sefcik T, Kapoor W. Syncope and orthostatic hypotension. Am J Med 1991; 91: 179-85.Mussi C, Ungar A, Salvioli G et al. Orthostatic hypotension as a cause of syncope in patients older than 65 years admitted to emergency departments for transient loss of consciousness. J Gerontol A Biol Sci Med Sci 2009; 64: 801-6.Mussi C, Ungar A, Salvioli G et al. Orthostatic hypotension as a cause of syncope in patients older than 65 years admitted to emergency departments for transient loss of consciousness. J Gerontol A Biol Sci Med Sci 2009; 64: 801-6.World Health Organization. Retrieved November 22, 2016, fr om http: //www.who.int/en/World Health Organization. Retrieved November 22, 2016, fr om http: //www.who.int/en/Wieling W, Krediet C.T, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 2007; 112 (3): 157-65.Wieling W, Krediet C.T, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 2007; 112 (3): 157-65.Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), Heart Rhythm Society (HRS), Moya A et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30 (21): 2631-71.Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), Heart Rhythm Society (HRS), Moya A et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30 (21): 2631-71.Stewart J.M. Transient orthostatic hypotension is common in adolescents. J Pediatr 2002; 140 (4): 418-24.Stewart J.M. Transient orthostatic hypotension is common in adolescents. J Pediatr 2002; 140 (4): 418-24.Ganzeboom K.S, Colman N, Reitsma J.B et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91: 1006-8, A1008.Ganzeboom K.S, Colman N, Reitsma J.B et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91: 1006-8, A1008.Stewart J.M, Clarke D. "He's Dizzy when he Stands Up". An Introduction to Initial orthostatic Hypotension. J Pediatr 2011; 158 (3): 499-504.Stewart J.M, Clarke D. "He's Dizzy when he Stands Up". An Introduction to Initial orthostatic Hypotension. J Pediatr 2011; 158 (3): 499-504.Wieling W, Dambrink J.H, Borst C. Cardiovascular effects of arising suddenly. N Engl J Med 1984; 310: 1189.Wieling W, Dambrink J.H, Borst C. Cardiovascular effects of arising suddenly. N Engl J Med 1984; 310: 1189.Tanaka H, Yamaguchi H, Matushima R, Tamai H. Instantaneous orthostatic hypotension in children and adolescents: a new clinical entitiy of orthostatic intolerance. Pediatr Res 1999; 46: 691-6.Tanaka H, Yamaguchi H, Matushima R, Tamai H. Instantaneous orthostatic hypotension in children and adolescents: a new clinical entitiy of orthostatic intolerance. Pediatr Res 1999; 46: 691-6.Thomas K.N, Cotter J.D, Galvin S.D et al. Initial orthostatic hypotension is unrelated to orthostatic tolerance in healthy young subjects. J Appl Physiol (1985) 2009; 107 (2): 506-17. DOI: 10.1152/japplphysiol.91650.2008Thomas K.N, Cotter J.D, Galvin S.D et al. Initial orthostatic hypotension is unrelated to orthostatic tolerance in healthy young subjects. J Appl Physiol (1985) 2009; 107 (2): 506-17. DOI: 10.1152/japplphysiol.91650.2008Kuz'mina Iu.V., Oshchepkova E.V., Rogoza A.N. et al. Different types of initial orthostatic depression reactions in hypertensive patients undergoing active tilt table testing. Ter. Arkh. 2008; 80 (4): 38-42.Kuz'mina Iu.V., Oshchepkova E.V., Rogoza A.N. et al. Different types of initial orthostatic depression reactions in hypertensive patients undergoing active tilt table testing. Ter. Arkh. 2008; 80 (4): 38-42.Romero-Ortuno R, Cogan L, Fan C.W, Kenny R.A. Intolerance to initial orthostasis relates to systolic BP changes in elders. Clin Auton Res 2010; 20 (1): 39-45.Romero-Ortuno R, Cogan L, Fan C.W, Kenny R.A. Intolerance to initial orthostasis relates to systolic BP changes in elders. Clin Auton Res 2010; 20 (1): 39-45.Imholz B.P.M, Dambrink J.H.A, Karenaker J.M, Wieling W. Orthostatic circulatory control in the elderly evaluated by continuous non-invasive blood pressure measurement. Clin Sci (Lond) 1990; 79: 73-9.Imholz B.P.M, Dambrink J.H.A, Karenaker J.M, Wieling W. Orthostatic circulatory control in the elderly evaluated by continuous non-invasive blood pressure measurement. Clin Sci (Lond) 1990; 79: 73-9.Romero-Ortuno R, Med L, Cogan L. Continuous non-invasive blood pressure measurements and their relationship with orthostatic intolerance, falls and frailty in older people. J Am Geriatr Soc 2011; 59: 655-65.Romero-Ortuno R, Med L, Cogan L. Continuous non-invasive blood pressure measurements and their relationship with orthostatic intolerance, falls and frailty in older people. J Am Geriatr Soc 2011; 59: 655-65.Streeten D.H, Anderson G.H. Delayed orthostatic intolerance. Arch Intern Med 1992; 152: 1066-72.Streeten D.H, Anderson G.H. Delayed orthostatic intolerance. Arch Intern Med 1992; 152: 1066-72.Gibbons C.H, Freeman R. Clinical implications of delayed orthostatic Hypotension. A 10-year follow-up study. Neurology 2015; 85: 1362-7.Gibbons C.H, Freeman R. Clinical implications of delayed orthostatic Hypotension. A 10-year follow-up study. Neurology 2015; 85: 1362-7.Gupta D, Nair M.D. Neurogenic orthostatic hypotension: chasing "the fall". Postgrad Med J 2008; 84 (987): 6-14.Gupta D, Nair M.D. Neurogenic orthostatic hypotension: chasing "the fall". Postgrad Med J 2008; 84 (987): 6-14.Gribbin B, Pickering T.G, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424-31.Gribbin B, Pickering T.G, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424-31.Davy K.P, Seals D.R, Tanaka H. Augmented cardiopulmonary and integrative sympathetic baroreflexes but attenuated peripheral vasoconstriction with age. Hypertension 1998; 32: 298-304.Davy K.P, Seals D.R, Tanaka H. Augmented cardiopulmonary and integrative sympathetic baroreflexes but attenuated peripheral vasoconstriction with age. Hypertension 1998; 32: 298-304.Maddens M, Lipsitz L.A, Wei J.Y et al. Impaired heart rate responses to cough and deep breathing in elderly patients with unexplained syncope. Am J Cardiol 1987; 60: 1368-72.Maddens M, Lipsitz L.A, Wei J.Y et al. Impaired heart rate responses to cough and deep breathing in elderly patients with unexplained syncope. Am J Cardiol 1987; 60: 1368-72.Gupta V, Lipsitz L.A. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med 2007; 120: 841-7.Gupta V, Lipsitz L.A. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med 2007; 120: 841-7.Low P.A. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care 2015; 21 (Suppl. 13): s248-s257.Low P.A. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care 2015; 21 (Suppl. 13): s248-s257.Pevzner A.V., Chuprova S.N., Kheymets G.I. et al. New algorithm of vasovagal syncope diagnostic. The third international symposium jn neurocardiology NEUROCARD, 2011. October 6th - 8th 2011, Belgrade, Serbia. Book of abstracts; p. 40.Pevzner A.V., Chuprova S.N., Kheymets G.I. et al. New algorithm of vasovagal syncope diagnostic. The third international symposium jn neurocardiology NEUROCARD, 2011. October 6th - 8th 2011, Belgrade, Serbia. Book of abstracts; p. 40.Певзнер А.В., Хеймец Г.И., Чупрова С.Н. и др. Патент №2470578. Способ определения причины обмороков различного происхожденияПевзнер А.В., Хеймец Г.И., Чупрова С.Н. и др. Патент №2470578. Способ определения причины обмороков различного происхожденияBiaggioni I. Treatment: special conditions: orthostatic hypotension. J Am Soc Hypertens 2015; 9 (1): 67-9. DOI: 10.1016/j.jash.2014.12.005Biaggioni I. Treatment: special conditions: orthostatic hypotension. J Am Soc Hypertens 2015; 9 (1): 67-9. DOI: 10.1016/j.jash.2014.12.005Low P.A, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol 7 (5): 451-8.Low P.A, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol 7 (5): 451-8.Zachariah P.K, Krier J, Schwartz G.L. Orthostatic hypotension and ambulatory blood pressure monitoring. J Hypertens (Suppl.) 1991; 9 (8): S78-80.Zachariah P.K, Krier J, Schwartz G.L. Orthostatic hypotension and ambulatory blood pressure monitoring. J Hypertens (Suppl.) 1991; 9 (8): S78-80.Ejaz A.A, Kazory A, Heinig M.E. 24-hour blood pressure monitoring in the evaluation of supine hypertension and orthostatic hypotension. Clin Hypertens (Greenwich) 2007; 9 (12): 952-5.Ejaz A.A, Kazory A, Heinig M.E. 24-hour blood pressure monitoring in the evaluation of supine hypertension and orthostatic hypotension. Clin Hypertens (Greenwich) 2007; 9 (12): 952-5.Schmidt C, Berg D, Herting P.S et al. Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov Disord 2009; 24 (14): 2136-42.Schmidt C, Berg D, Herting P.S et al. Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov Disord 2009; 24 (14): 2136-42.Logan I.C, Witham M.D. Efficacy of treatments for orthostatic hypotension: a systematic review. Age Ageing 2012; 41: 587-94.Logan I.C, Witham M.D. Efficacy of treatments for orthostatic hypotension: a systematic review. Age Ageing 2012; 41: 587-94.Jordan J, Shannon J.R, Grogan E et al. A potent pressor response elicited by drinking water. Lancet 1999; 353: 723.Jordan J, Shannon J.R, Grogan E et al. A potent pressor response elicited by drinking water. Lancet 1999; 353: 723.Krediet C.T, van Lieshout J.J, Bogert L.W et al. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study. Am J Physiol Heart Circ Physiol 2006; 291: H1768-H1772.Krediet C.T, van Lieshout J.J, Bogert L.W et al. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study. Am J Physiol Heart Circ Physiol 2006; 291: H1768-H1772.Diedrich A, Biaggioni I. Segmental orthostatic fluid shifts. Clin Auton Res 2004; 14: 146-7.Diedrich A, Biaggioni I. Segmental orthostatic fluid shifts. Clin Auton Res 2004; 14: 146-7.Hickler R.B, Thompson G.R, Fox L.M, Hamlin J.T. Successful treatment of orthostatic hypotension with 9-alpha-fluorohydrocortisone. N Engl J Med 1959; 261: 788-91.Hickler R.B, Thompson G.R, Fox L.M, Hamlin J.T. Successful treatment of orthostatic hypotension with 9-alpha-fluorohydrocortisone. N Engl J Med 1959; 261: 788-91.Van Lieshout J.J, Ten Harkel A.D, Wieling W. Fludrocortisone and sleeping in the head-up position lim it the postural decrease in cardiac output in autonomic failure. Clin Auton Res 2000; 10: 35-42.Van Lieshout J.J, Ten Harkel A.D, Wieling W. Fludrocortisone and sleeping in the head-up position lim it the postural decrease in cardiac output in autonomic failure. Clin Auton Res 2000; 10: 35-42.Singer W, Opfer-Gehrking T.L, McPhee B.R et al. Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension. J Neurol Neurosurg Psychiatry 2003; 74: 1294-8.Singer W, Opfer-Gehrking T.L, McPhee B.R et al. Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension. J Neurol Neurosurg Psychiatry 2003; 74: 1294-8.Shibao C, Okamoto L.E, Gamboa A et al. Comparative efficacy of yohimbine against pyridostigmine for the treatment of orthostatic hypotension in autonomic failure. Hypertension 2010; 56: 847-51.Shibao C, Okamoto L.E, Gamboa A et al. Comparative efficacy of yohimbine against pyridostigmine for the treatment of orthostatic hypotension in autonomic failure. Hypertension 2010; 56: 847-51.Ramirez C.E, Okamoto L.E, Arnold A.C et al. Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure. Hypertension 2014; 64: 1235-40.Ramirez C.E, Okamoto L.E, Arnold A.C et al. Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure. Hypertension 2014; 64: 1235-40.Strieper M.J, Campbell R.M. Efficacy of alpha-adrenergic agonist therapy for prevention of pediatric neurocardiogenic syncope. J Am Coll Cardiol 1993; 22: 594-7.Strieper M.J, Campbell R.M. Efficacy of alpha-adrenergic agonist therapy for prevention of pediatric neurocardiogenic syncope. J Am Coll Cardiol 1993; 22: 594-7.Jordan J, Shannon J.R, Biaggioni I et al. Contrasting actions of pressor agents in severe autonomic failure. Am J Med 1998; 105: 116-24.Jordan J, Shannon J.R, Biaggioni I et al. Contrasting actions of pressor agents in severe autonomic failure. Am J Med 1998; 105: 116-24.Juraschek S.P, Daya N, Appel L.J. et al. Orthostatic Hypotension in Middle-Age and Risk of Falls. Am J Hypertens 2016.Juraschek S.P, Daya N, Appel L.J. et al. Orthostatic Hypotension in Middle-Age and Risk of Falls. Am J Hypertens 2016.Willie C.K, Tzeng Y.C, Fisher J.A, Ainslie P.N. Integrative regulation of human brain blood flow. J Physiol 2014; 592: 841-59.Willie C.K, Tzeng Y.C, Fisher J.A, Ainslie P.N. Integrative regulation of human brain blood flow. J Physiol 2014; 592: 841-59.Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure https: //doi.org/10.1161/HYP.0000000000000065. Hypertension 2017.Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure https: //doi.org/10.1161/HYP.0000000000000065. Hypertension 2017.Biaggioni I, Robertson R.M. Hypertension in orthostatic hypotension and autonomic dysfunction. Cardiol Clin 2002; 20: 291-301.Biaggioni I, Robertson R.M. Hypertension in orthostatic hypotension and autonomic dysfunction. Cardiol Clin 2002; 20: 291-301.Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens 2002; 4: 139-45.Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens 2002; 4: 139-45.Goldstein D.S, Holmes C, Dendi R et al. Orthostatic hypotension from sympathetic denervation in Parkinson’s disease. Neurology 2002; 58: 1247-55.Goldstein D.S, Holmes C, Dendi R et al. Orthostatic hypotension from sympathetic denervation in Parkinson’s disease. Neurology 2002; 58: 1247-55.Shannon J.R, Diedrich A, Biaggioni I et al. Water drinking as a treatment for orthostatic syndromes. Am J Med 2002; 112: 355-60.Shannon J.R, Diedrich A, Biaggioni I et al. Water drinking as a treatment for orthostatic syndromes. Am J Med 2002; 112: 355-60.Masuo K, Mikami H, Ogihara T et al. Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications. Am J Hypertens 1996; 9: 263-8.Masuo K, Mikami H, Ogihara T et al. Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications. Am J Hypertens 1996; 9: 263-8.Lagi A, Rossi A, Cornelli A et al. Postural hypotension in hypertensive patients. Blood Pressure 2003; 12: 340-4.Lagi A, Rossi A, Cornelli A et al. Postural hypotension in hypertensive patients. Blood Pressure 2003; 12: 340-4.Ejaz A.A, Haley W.E, Wasiluk A et al. Characteristics of consecutive patients presenting with orthostatic hypotension. Mayo Clin Proc 2004; 79 (7): 890-4.Ejaz A.A, Haley W.E, Wasiluk A et al. Characteristics of consecutive patients presenting with orthostatic hypotension. Mayo Clin Proc 2004; 79 (7): 890-4.Romero-Ortuno R O’Connell M.D.L, Finucane C et al. Insights into the clinical management of the syndrome of supine hypertension - orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA). Geriatrics 2013; 13: 73.Romero-Ortuno R O’Connell M.D.L, Finucane C et al. Insights into the clinical management of the syndrome of supine hypertension - orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA). Geriatrics 2013; 13: 73.Naschitz J.E, Slobodin G, Elias N, Rosner I. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J 2006; 82: 246-53.Naschitz J.E, Slobodin G, Elias N, Rosner I. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J 2006; 82: 246-53.Jordan J, Shannon J.R, Pohar B et al. Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure. J Am Soc Nephrol 1999; 10: 35-42.Jordan J, Shannon J.R, Pohar B et al. Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure. J Am Soc Nephrol 1999; 10: 35-42.Arnold A.C, Biaggioni I. Management approaches to hypertension in autonomic failure. Curr Opin Nephrol Hypertens 2012; 21: 481-5.Arnold A.C, Biaggioni I. Management approaches to hypertension in autonomic failure. Curr Opin Nephrol Hypertens 2012; 21: 481-5.White N.J. Heart-rate changes on standing in elderly patients with orthostatic hypotension. Clin Sci 2008; 58 (5): 411-13. Cons 2016.White N.J. Heart-rate changes on standing in elderly patients with orthostatic hypotension. Clin Sci 2008; 58 (5): 411-13. Cons 2016.

The authors declare that there are no conflicts of interest present.