Orthostatic Hypotension and Diaphoresis

Definition and Diagnosis

• Neurogenic Orthostatic Hypotension (nOH) is defined as a fall in blood pressure of at least 15 mm Hg systolic and 10 mm Hg diastolic after standing for at least 2 minutes, often accompanied by symptoms including diaphoresis, as stated by the American Journal of Kidney Diseases 1, 2
• The American Diabetes Association recommends considering diabetic autonomic neuropathy in patients with diabetes who develop autonomic dysfunction that can present with orthostatic hypotension and associated diaphoresis 3, 4

Clinical Assessment and Management

• The European Society of Cardiology recommends waiting at least 2 minutes before measuring vital signs in the supine position and at least 1 minute before measuring vital signs in the upright position, using a properly sized blood pressure cuff and keeping it at heart level, when evaluating orthostatic changes 5
• The American Diabetes Association suggests that adequate salt intake is a non-pharmacologic measure to address orthostatic hypotension and associated symptoms like diaphoresis 4
• Midodrine is a pharmacologic option for symptomatic orthostatic hypotension, as recommended by the American Diabetes Association 4

Prognosis and Clinical Pearls

• In patients with heart failure and high filling pressures, orthostatic changes may paradoxically improve hemodynamics, potentially affecting symptom presentation, as noted by the European Society of Cardiology 5, 6