Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension

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The intention of our article is to help guide fellow clinicians in the care of patients with nOH and cardiovascular conditions. Our work is largely based on data from published literature, but there are many aspects of managing nOH in patients with cardiovascular disease that remain unclear or unknown. To supplement these evidence gaps, we provide practical guidance and recommendations based on our clinical experiences treating this patient population. Our article focuses on specific treatment considerations for co-management of nOH and cardiovascular disease, including factors that can lead to exacerbation of nOH and concomitant symptoms (eg, drugs commonly used to treat cardiovascular disorders, such as vasodilators and β-blockers) and how to safety and effectively manage nOH using nonpharmacologic (eg, water ingestion, abdominal compression) and pharmacologic (eg, droxidopa, midodrine) strategies. We believe the information in our article will enable healthcare providers to balance nOH symptom relief while minimizing risk of adverse outcomes in their patients with nOH and cardiovascular disease.

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