Orthostatic Hypotension (Neurogenic)

Neurogenic orthostatic hypotension is a sustained blood pressure drop upon standing due to autonomic nervous system dysfunction. Etiologies include neurodegenerative disorders (e.g., Parkinson disease, multiple system atrophy) or peripheral autonomic neuropathies. Pathophysiology involves impaired sympathetic vasoconstriction and baroreflex failure. Diagnosis is based on blood pressure measurements, autonomic testing, and exclusion of secondary causes. Management includes non-pharmacologic measures (fluid/salt intake, compression garments) and pharmacologic therapy (midodrine, fludrocortisone); prognosis depends on underlying disorder and symptom control.