Delayed Orthostatic Hypotension

Background:  OH usually defined as drop of 20/10mmHg within 3 minutes of standing.  After 3 min, called delayed OH.
n = 230 pts referred for autonomic testing
50 had OH, 58 had DOH, 122 had neither
(2006 study)
Follow-up study:
10-year mortality 64% in OH patients, 29% in DOH pts, 9% among age- and sex-matched patients without either.
Among 48 DOH patients, 26 developed OH (14 of which had Parkinson’s, LBD, MSA or pure autonomic failure)
None of the DOH patients without progression to OH had the above diseases.
T2DM common in all groups.
In some patients, DOH can progress to OH, and this can be a harbinger of PD, LBD, MSA, etc. (alpha-synucleinopathies).
However, about a third of pts with OH and progressive DOH were on meds that could affect autonomic NS, but they were held 24h prior to testing.
Neurology 2015 Oct 20; 85:1362

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