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Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo

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Abstract

Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be the most common symptom of OH. However, recent studies have demonstrated that 30–39 % of patients with OH experienced rotatory vertigo during upright posture (i.e., orthostatic vertigo, OV), which challenges the dogma that OH induces dizziness and not vertigo. A recent population-based study on spontaneously occurring OD across a wide age range showed that the one-year and lifetime prevalence of OD was 10.9 and 12.5 %, respectively. Approximately 83 % of patients with OD had at least one abnormal autonomic function test result. So far, 11 subtypes of OD have been proposed according to the pattern of autonomic dysfunction, and generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions was the most common type. Four different patterns of OH, such as classic, delayed, early, and transient type have been found in patients with OD. The head-up tilt test and Valsalva maneuver should be performed for a comprehensive evaluation of sympathetic adrenergic failure in patients with OD/OV. This review summarizes current advances in OH presenting OD/OV, with a particular focus on the autonomic dysfunction associated with OD.

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Author notes

    Authors and Affiliations

    1. Department of Neurology, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea

      Hyun-Ah Kim, Hyon-Ah Yi & Hyung Lee

    2. Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea

      Hyun-Ah Kim, Hyon-Ah Yi & Hyung Lee

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    1. Hyun-Ah Kim
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    2. Hyon-Ah Yi
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    3. Hyung Lee
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    Correspondence to Hyung Lee.

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    The authors declared that they have no conflict of interests. Dr. Lee serves on the editorial boards of Frontiers in Neuro-otology, Research in Vestibular Science, and Current Medical Imaging Review. Drs. Kim and Yi report no disclosures.

    Additional information

    H.-A. Kim and H.-A. Yi equally contributed as co-first authors to this work.

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    Kim, HA., Yi, HA. & Lee, H. Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo. Neurol Sci 36, 1995–2002 (2015). https://doi.org/10.1007/s10072-015-2363-2

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