Principle of management | Intervention |
---|---|
General principles of management | Educate on avoiding triggers and encouraging self-management, such as patient diaries. Review medications. Treat anaemia, B12 deficiency, optimise causes of autonomic neuropathy (HIV/amyloidosis/diabetes). |
Non-pharmacological measures | Aim for fluid repletion (2–2.5 L) and 500 mL bolus when needed. Aim for salt repletion (4–10 g/day). Prescribe compression garments to include abdominal compression. Teach physical counter-manoeuvres. Demonstrate head-up sleeping (by at least 10 degrees). |
Pharmacological measures | Volume expanders: fludrocortisone Sympathomimetics: midodrine Alternative agents: droxidopa, atomoxetine and pyridostigmine |
Managing OH and nSH | Advise taking a low-dose short-acting anti-hypertensive at night. Encourage a snack at night to induce post-prandial hypotension. Advise to avoid water and vasopressor agents at night. |
OH = orthostatic hypotension; nSH = neurogenic/nocturnal supine hypertension.