Symptomatic Neurogenic Orthostatic Hypotension

Symptomatic Neurogenic Orthostatic Hypotension

Symptomatic Neurogenic Orthostatic Hypotension (NOH) is a medical condition caused by a dysfunction of the autonomic nervous system. This disorder can cause low blood pressure, symptoms such as dizziness upon standing, fatigue, and a decrease in heart rate when standing.

NOH can be caused by a variety of conditions, including diabetes, multiple system atrophy, Parkinson's disease, familial dysautonomia and pure autonomic failure. It can also be caused by medications, dehydration, and certain genetic conditions.

Signs and Symptoms

The primary symptom of NOH is a sudden drop in blood pressure when a person stands. This can cause lightheadedness, blurred vision, dizziness, and fainting. Other symptoms include fatigue, nausea, and feeling weak in the legs.


Diagnosis of NOH usually begins with a physical exam and medical history. This is followed by a tilt table test, which measures how quickly blood pressure drops when standing. Imaging tests, such as an MRI or CT scan, may be ordered to check for any damage to the autonomic nervous system.


Treatment of NOH focuses on reducing symptoms and maintaining blood pressure. This typically includes lifestyle changes, such as increasing salt and water intake, exercising, and avoiding alcohol and drugs. Medications may also be prescribed, including fludrocortisone (to increase blood volume) and midodrine (to increase blood pressure). In some cases, surgery may be necessary.


The primary complication of NOH is the risk of falls due to dizziness and lightheadedness. This can lead to fractures and head injuries. There is also the risk of dehydration and electrolyte imbalances. Long-term complications can include chronic fatigue and weakness.


The best way to prevent NOH is to manage any underlying conditions, such as diabetes or heart disease. Maintaining a healthy lifestyle, including regular exercise, can also reduce the risk of developing NOH.