michigan hypertension core curriculum - State of Michigan

markers (RF, Anti SS-A or SS-B)
Imaging and Other tests
The following tests may be indicated as directed by clinical suspicion:
1- EKG/Telemetry
2- CT head or brain MRI
3- Tilt table testing
4- Nerve conduction studies or EMG
5- Bladder ultrasound
6- Lumbar puncture
Management and Treatment
Nonpharmacological treatments include:
1- Treatment of underlying etiology if possible (e.g., improved glycemic control in diabetic
neuropathy)
2- Correction of volume depletion
3- Physical maneuvers (e.g., slow assumption of upright posture after sleep, avoiding isometric
exercise, tensing of lower body muscles)
4- Compression stockings
5- Deliberate volume expansion with increased water intake or saline infusion
6- Elevating the head of bed on blocks (15 cm or approximately 5 degrees) to prevent nocturnal
baroreceptor deactivation. 6,7
Pharmacological treatments can be used for symptomatic relief. Much of the treatment is anecdotal
and the reader is referred to recent reviews 5,8,9 for details. It is unknown whether or not symptomatic
treatment reduces the morbidity and mortality associated with orthostatic hypotension. Before adding
medications for the treatment of orthostatic hypotension, medications known to cause or exacerbate
the syndrome should be discontinued or decreased if possible. Antihypertensive medications should be
adjusted to maintain a normal standing BP. It is understood that this frequently results in considerable
elevation of supine or seated blood pressures
NKFM & MDCH 219