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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 65-year-old man reports a 6-month history of dizziness, light-headedness, weakness, and fatigue while upright. He takes no medication and has no personal or family history of neurologic disease. On physical examination, his supine blood pressure is 160/100 mm Hg, with a heart rate of 72 beats per minute; on standing, his blood pressure falls to 70/40 mm Hg, with no change
The Clinical Problem
Physiological and Clinical Features
Causes of Neurogenic Orthostatic Hypotension
Strategies and Evidence
Evaluation
Treatment
Nonpharmacologic Interventions
Pharmacologic Interventions
Areas of Uncertainty
Guidelines from Professional Societies
Conclusions and Recommendations
Source Information
From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
Address reprint requests to Dr. Freeman at the Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd., Boston, MA 02215, or at rfreeman@bidmc.harvard.edu.
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