Pathophysiological basis of orthostatic hypotension in autonomic failure
- *Department of Internal Medicine, Academic Medical Centre, University of Amsterdam Amsterdam, The Netherlands
- †Department of Anesthesiology and Autonomic Reflex Laboratory Rochester, USA
- ‡Department of Neurology, Mayo Clinic and Foundation Rochester, USA
- Corresponding author W. Wieling: Deptartment of Internal Medicine (F4-222), Academic Medical Centre, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Email: w.wieling{at}amc.uva.nl
Abstract
In patients with autonomic failure orthostatic hypotension results from an impaired capacity to increase vascular resistance during standing. This fundamental defect leads to increased downward pooling of venous blood and a consequent reduction in stroke volume and cardiac output that exaggerates the orthostatic fall in blood pressure. The location of excessive venous blood pooling has not been established so far, but present data suggest that the abdominal compartment and perhaps leg skin vasculature are the most likely candidates. To improve the orthostatic tolerance in patients with autonomic failure, protective measures that reduce excessive orthostatic blood pooling have been developed and evaluated. These measures include physical counter-manoeuvres and abdominal compression.
Footnotes
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- Received December 17, 1998.
- Accepted June 16, 1999.
- © The Physiological Society 1999
