scholarly journals Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension

2021 ◽  
Vol 21 (4) ◽  
Author(s):  
Stuart H. Isaacson ◽  
Khashayar Dashtipour ◽  
Ali A. Mehdirad ◽  
Amanda C. Peltier
Keyword(s):  
Orthostatic Hypotension ◽  
Treatment Approach ◽  
Management Strategies ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
Individualized Approach ◽  
Short And Long Term ◽  
Cerebrovascular Risk ◽  
Pharmacologic Treatments

AbstractPurpose of ReviewIn autonomic failure, neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are interrelated conditions characterized by postural blood pressure (BP) dysregulation. nOH results in a sustained BP drop upon standing, which can lead to symptoms that include lightheadedness, orthostatic dizziness, presyncope, and syncope. nSH is characterized by elevated BP when supine and, although often asymptomatic, may increase long-term cardiovascular and cerebrovascular risk. This article reviews the pathophysiology and clinical characteristics of nOH and nSH, and describes the management of patients with both nOH and nSH.Recent FindingsPressor medications required to treat the symptoms of nOH also increase the risk of nSH. Because nOH and nSH are hemodynamically opposed, therapies to treat one condition may exacerbate the other. The management of patients with nOH who also have nSH can be challenging and requires an individualized approach to balance the short- and long-term risks associated with these conditions.SummaryApproaches to manage neurogenic BP dysregulation include nonpharmacologic approaches and pharmacologic treatments. A stepwise treatment approach is presented to help guide neurologists in managing patients with both nOH and nSH.

603 CHALLENGES IN THE MANAGEMENT OF SEVERE ORTHOSTATIC HYPOTENSION ASSOCIATED WITH SUPINE HYPERTENSION IN A PATIENT WITH AUTONOMIC DYSFUNCTION ON BACKGROUND OF NASOPHARYNGEAL CARCINOMA AND TYPE II DIABETES MELLITUS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
Q M N Rachel ◽  
K Mamun ◽  
M H Nguyen
Keyword(s):  
Blood Pressure ◽  
Nasopharyngeal Carcinoma ◽  
Orthostatic Hypotension ◽  
Carotid Sinus ◽  
Blood Pressure Monitoring ◽  
Pharmacological Interventions ◽  
Supine Hypertension ◽  
Neck Irradiation ◽  
Baroreflex Failure

Abstract Introduction Combined chemotherapy and radiotherapy increases long term survival in patients with nasopharyngeal carcinoma. However, radiotherapy of the carotid sinus or brain stem can evolve labile hypertension and orthostatic intolerance from chronic baroreflex failure. Diabetes would also cause this neuropathy. Management of patients with Supine hypertension-Orthostatic hypotension can be very challenging. Methods A case report was done on a 71-year-old man with metastatic nasopharyngeal carcinoma status post radiation therapy who was admitted with severe supine hypertension-orthostatic hypotension. Patient was managed with both non-pharmacological and pharmacological methods, and monitored for postural symptoms, complications of severe supine hypertension—which has been linked to left ventricular hypertrophy and kidney dysfunction, and placed on 24 hour ambulatory blood pressure monitoring to aid in management so as to prevent hypertension induced organ damage. Results This review outlines the pathophysiology of Supine hypertension-Orthostatic hypotension, treatment complications and potential management strategies recommendations for this group of patients. It revealed the benefit of having a 24 hour ambulatory blood pressure monitoring, which provides insight on the timing and magnitude of an individual’s blood pressure fluctuations throughout the day so as to further guide management. Conclusion Chronic baroreflex failure is a late sequela of neck irradiation for naso-pharyngeal carcinoma due to accelerated atherosclerosis in the region of the carotid sinus baroreceptor. Treatment goal is achieved with adequate control of pre-syncopal symptoms and prevention of long term complications. Non-pharmacological interventions remain the first line of therapy, followed by pharmacological interventions as necessary. Nonetheless, management of blood pressure in these elderly patients with baroreflex dysfunction remains challenging and should be individualized. Moving forward, a prospective study on the incidence of late onset, iatrogenic baroreflex failure as a late complication of neck irradiation and its particular relationship to carotid arterial rigidity should be conducted to increase awareness, timely diagnosis and management of the condition among physicians.

Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials

2018 ◽  
Vol 52 (12) ◽  
pp. 1182-1194 ◽  
Author(s):  
Jack J. Chen ◽  
Yi Han ◽  
Jonathan Tang ◽  
Ivan Portillo ◽  
Robert A. Hauser ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Fixed Effects ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Mixed Treatment Comparison ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
Treatment Comparison ◽  
Mixed Treatment

Background: The comparative effects of droxidopa and midodrine on standing systolic blood pressure (sSBP) and risk of supine hypertension in patients with neurogenic orthostatic hypotension (NOH) are unknown. Objective: To perform a Bayesian mixed-treatment comparison meta-analysis of droxidopa and midodrine in the treatment of NOH. Methods: The PubMed, CENTRAL, and EMBASE databases were searched up to November 16, 2016. Study selection consisted of randomized trials comparing droxidopa or midodrine with placebo and reporting on changes in sSBP and supine hypertension events. Data were pooled to perform a comparison among interventions in a Bayesian fixed-effects model using vague priors and Markov chain Monte Carlo simulation with Gibbs sampling, calculating pooled mean changes in sSBP and risk ratios (RRs) for supine hypertension with associated 95% credible intervals (CrIs). Results: Six studies (4 administering droxidopa and 2 administering midodrine) enrolling a total of 783 patients were included for analysis. The mean change from baseline in sSBP was significantly greater for both drugs when compared with placebo (droxidopa 6.2 mm Hg [95% CrI = 2.4-10] and midodrine 17 mm Hg [95% CrI = 11.4-23]). Comparative analysis revealed a significant credible difference between droxidopa and midodrine. The RR for supine hypertension was significantly greater for midodrine, but not droxidopa, when compared with placebo (droxidopa RR = 1.4 [95% CrI = 0.7-2.7] and midodrine RR = 5.1 [95% CrI = 1.6-24]). Conclusion and Relevance: In patients with NOH, both droxidopa and midodrine significantly increase sSBP, the latter to a greater extent. However, midodrine, but not droxidopa, significantly increases risk of supine hypertension.

scholarly journals The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension

2020 ◽  
Vol 75 ◽  
pp. 97-104 ◽  
Author(s):  
Jose-Alberto Palma ◽  
Gabriel Redel-Traub ◽  
Angelo Porciuncula ◽  
Daniela Samaniego-Toro ◽  
Patricio Millar Vernetti ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
The Impact

scholarly journals The Progressive Response of Sahelian Dams to Sediment Intrusion: Case of Kano State between 1976 and 2009

2015 ◽  
Vol 773-774 ◽  
pp. 1301-1306
Author(s):  
Mahadi Lawan Yakubu ◽  
Usman Tasiu Abdurrahman ◽  
Muhammad Tajuri Ahmed ◽  
Amina Sallau Aliyu ◽  
Muttaqa Uba Zango ◽  
...  
Keyword(s):  
Management Strategies ◽  
Water Storage ◽  
Time Frame ◽  
Mitigation Strategy ◽  
The State ◽  
Best Management ◽  
The Future ◽  
Short And Long Term

Reservoirs are built to store water during abundance for possible reuse during scarcity; sediment incursion is the leading phenomenon that limit reservoirs to sustain this function. Therefore, modelling the rate at which reservoir accumulates sediments is critical in understanding the nature of the problem, the time frame within which it is expected to occur, and the best mitigation strategy that will maintain the reservoir service. This study investigated the sediment influx in three typical Sahelian reservoirs in Kano state using the bathymetric method. The reservoir capacities were found to be declining at different rates but with grave consequences on the future, and economy of the state. In prolific terms, the state is losing 490 million litres of water storage each year. Presently, Magaga lost 39% of its capacity; Thomas has lost 13%; while Kafin-chiri has lost 5%. For sustainability, this trend needs to be addressed. The short and long-term best management strategies to curtail this trend have been outlined in this study.

Opioid Analgesics for Sedation and Analgesia During Mechanical Ventilation

2015 ◽  
Vol 34 (2) ◽  
pp. 113-116 ◽  
Author(s):  
Brandy Zeller ◽  
Jeanne Giebe
Keyword(s):  
Pain Management ◽  
Adverse Reactions ◽  
Management Strategies ◽  
Opioid Analgesics ◽  
Chronic Complications ◽  
Mechanically Ventilated ◽  
Routine Administration ◽  
Sedation And Analgesia ◽  
Short And Long Term

AbstractNeonates are exposed to repetitive pain and stress during their stay in a NICU, which can lead to chronic complications related to their neurodevelopment and neurobehavior. Approximately 20 percent of all neonates in a NICU are intubated, mechanically ventilated, and require suctioning, which can cause both acute and chronic pain. Pain management in the neonate can be challenging. Nurses and other caregivers need to be well trained to assess pain in the neonate to effectively identify and provide appropriate pain management strategies. There is a lack of evidence to support routine administration of opiates in the neonate. As with any medication, the possibility of short- and long-term adverse reactions must be considered. Nonpharmacologic therapy should be used as much as possible.

Managing growth overfishing with multiannual compromise strategies

1997 ◽  
Vol 54 (10) ◽  
pp. 2255-2276 ◽  
Author(s):  
P Marchal
Keyword(s):  
Management Strategies ◽  
Fishing Effort ◽  
Reference Points ◽  
Long Term Outcomes ◽  
Northeast Atlantic ◽  
Factors Influencing ◽  
Optimal Balance ◽  
Short And Long Term ◽  
Mobile Target

Most of the Northeast Atlantic stocks are currently fished above the biological reference points (e.g., Fmax). In attempting to achieve such targets, advisers and managers have faced two main problems. First, it is impractical to (i) simultaneously maximize yields, stabilize fisheries, and safeguard stocks and (ii) optimize both short- and long-term outcomes for the industry. Second is the lack of predictability, several years ahead, in factors influencing decisions. This study addresses these twin issues by exploring the relative performances of various multiannual and compromise (or composite) management strategies. Multiannual fishing efforts are set in advance for a ``resolution'' period of several years, at the end of which they are updated. They are calculated to satisfy a prior weighted compromise amongst three criteria: (i) minimizing fishing effort variability, (ii) minimizing catch variability, and (iii) reaching a ``mobile target:'' the latter is defined with a second weighted compromise between the long-term target and the fishing effort at the beginning of the resolution period. A safe and optimal balance between all the short- and long-term fishery outcomes is found with a 5-year resolution period, during which the mobile target is split into 40-60% of the long-term target, and 60-40% of the fishing effort at the start of the resolution period, while criteria i, ii, and iii are weighted equally.

Abstract P379: Patient and Caregiver Experiences With the Diagnosis of Neurogenic Orthostatic Hypotension

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Lawrence A Hewitt ◽  
Charles H Adler ◽  
Daniel O Claassen ◽  
Christopher H Gibbons ◽  
Satish R Raj
Keyword(s):  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Pure Autonomic Failure ◽  
Accurate Diagnosis ◽  
First Year ◽  
Neurogenic Orthostatic Hypotension ◽  
Postural Change ◽  
Sustained Reduction ◽  
Caregiver Experiences

Objective: To understand the challenges to diagnosis in patients with neurogenic orthostatic hypotension (nOH) Background: nOH is a sustained reduction in blood pressure (BP) with postural change associated with autonomic dysfunction. Despite symptoms of nOH, many patients struggle to find an accurate diagnosis. Methods: An online, US-based survey designed by the authors was conducted by Harris Poll. Eligible participants were ≥18 years of age with Parkinson disease, multiple system atrophy, or pure autonomic failure and ≥1 of the following: orthostatic hypotension (OH), nOH, low BP, OH/nOH symptoms, or were caregivers of eligible participants. Results: The survey included 363 patients and 128 caregivers. Groups were separate, where caregivers were not the caregivers to patient responders. Respondents indicated that patients experienced nOH symptoms long term (Table 1) . Most patients (69%) and caregivers (59%) reported discussing nOH symptoms with a healthcare provider (HCP) within the first year of symptom onset, but only 36% of patients and 16% of caregivers reported a formal diagnosis of OH or nOH. Of those with a formal diagnosis, the majority of patients (50%) were frustrated by the path to diagnosis and more than 40% of patients and caregivers reported that the patient saw ≥3 HCPs before diagnosis. After diagnosis, most patients (70%) and caregivers (60%) reported improved symptom management. Conclusions: This survey reveals that patients and caregivers may find the path to nOH diagnosis challenging and suggests increased awareness among HCPs is needed. Once a diagnosis is made nOH symptoms are better managed.

scholarly journals Current Status of Distal Embolization in Femoropopliteal Endovascular Interventions

2018 ◽  
Vol 52 (6) ◽  
pp. 440-447 ◽  
Author(s):  
Alessandro Cannavale ◽  
Mariangela Santoni ◽  
Marianna Gazzetti ◽  
Carlo Catalano ◽  
Fabrizio Fanelli
Keyword(s):  
Management Strategies ◽  
Major Amputation ◽  
Current Status ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Distal Embolization ◽  
Endovascular Interventions ◽  
Atherosclerotic Lesions ◽  
Short And Long Term

The application of advanced endovascular techniques in very complex femoropopliteal atherosclerotic lesions has shown to expose patients to a higher risk of distal embolization (DE). This complication can affect both the short- and long-term outcomes, leading to worsening ischemia, early minor/major amputation, and longer hospital stay. Recently, there has been an increasing body of evidence on pathophysiology and clinical–radiological management of DE that however has not been systematically addressed by guidelines. The aim of this review was to analyze the current evidence outlining definition and classification, risk assessment, prevention, and management strategies of DE in femoropopliteal endovascular interventions.

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