The following article is part of conference coverage from the 2019 American Association of Nurse Practitioners Annual Meeting (AANP 2019) in Indianapolis, Indiana. Clinical Advisor’s staff will be reporting breaking news associated with research conducted by leading nurse practitioners. Check back for the latest news from AANP 2019.


Considering neurogenic orthostatic hypotension as an underlying cause of syncope can help clinicians appropriately diagnose and treat patients, which can increase clinician understanding and reduce patient symptomatic burden, according to results presented at the American Association of Nurse Practitioners 2019 annual meeting held June 18 to 23, 2019 in Indianapolis, IN.

Investigators conducted a case study assessing a 62-year-old man with a history of Hodgkin lymphoma, lupus, type 2 diabetes, neuropathy, hypercholesterolemia, hypothyroidism, and orthostatic hypotension. The man was evaluated for syncope, collapse, and fluctuating blood pressure (BP) through routine examination and autonomic function tests, which included tilt-table test with continuous electrocardiography, transcranial Doppler, and BP and heart rate monitoring in increments of 2 minutes.

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The patient had a 2-year history of syncope, which progressively exacerbated over a 3-month duration. Dizziness preceded syncope episodes; upon worsening, nausea also began to occur. He had a 5-year history of orthostatic hypotension and reported that midodrine and fludrocortisone did not relieve symptoms.

Following tilt-table and Valsalva maneuver test results, the patient was diagnosed with neurogenic orthostatic hypotension and prescribed 100 mg BID droxidopa; due to his hypertension, the patient was also prescribed a 0.2 mg nightly nitroglycerin patch.

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Droxidopa treatment significantly relieved the patient’s symptoms and improved his ability to perform daily activities. In addition, he no longer lost consciousness when altering his physical position, though he still experienced some symptoms of presyncope. Overall, the patient and his family reported that symptomatic burden had decreased.

“Increase awareness of [neurogenic orthostatic hypotension] as a potential cause of syncope and understanding of appropriate diagnostic techniques and management for the condition can help improve patient care,” the authors noted. “Autonomic function testing can lead to timely diagnosis of [neurogenic orthostatic hypotension] and effective intervention to manage [neurogenic orthostatic hypotension] symptoms.”

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Alam SB, Almardini W, Suleman A. Utility of autonomic testing for the diagnosis of neurogenic orthostatic hypotension and subsequent management of droxidopa. Presentation at: The American Association of Nurse Practitioners Annual Meeting; June 18-23, 2019; Indianapolis, IN. Poster 14.