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July 25, 1994

Causes of Chronic Orthostatic Hypotension

Author Affiliations

From the Departments of Medicine (Drs D. and R. M. Robertson), Pharmacology (Dr D. Robertson), and Neurology (Dr D. Robertson), Vanderbilt University, Nashville, Tenn.

Arch Intern Med. 1994;154(14):1620-1624. doi:10.1001/archinte.1994.00420140086011

Objective:  To determine the frequency of various causes of orthostatic hypotension.

Design:  Survey.

Setting:  Tertiary referral center.

Patients:  One hundred patients with moderate to severe orthostatic hypotension.

Results:  Twenty-seven percent of the patients had primary autonomic failure, 35% had secondary autonomic failure, and 38% had hypotension without evidence of generalized autonomic degeneration.

Conclusions:  In a tertiary referral center, only a minority of patients with severe orthostatic hypotension will have Shy-Drager syndrome or Bradbury-Eggleston syndrome as their primary disease. Occasional patients who initially appear to have Bradbury-Eggleston syndrome ultimately prove to have Shy-Drager syndrome or paraneoplastic autonomic failure. Antidepressant drugs, even in low doses, remain a major overlooked cause of orthostatic hypotension.(Arch Intern Med. 1994;154:1620-1624)