{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:22:11Z","timestamp":1790630531131,"version":"4.1.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Orthostatic hypertension (OHT) is the clinical opposite to orthostatic hypotension and is an under-recognized and poorly understood clinical phenomenon. Patients may experience disabling symptoms such as dizziness, chest pain, and shortness of breath. In addition, OHT is associated with important clinical outcomes such as silent cerebral infarcts and cognitive decline.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present the case of a 67-year-old female who experienced frequent drop attacks with and without transient loss of consciousness causing various injuries. A range of standard diagnostic procedures did not yield an explanation for her symptoms but head-up tilt (HUT) testing showed OHT and induced most of her symptoms. Upon initiation of doxazosin, an alpha-blocking drug, she was free of symptoms and blood pressure response was normal on the repeat HUT test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>To our knowledge, this is the first report of syncope due to OHT. Orthostatic hypertension is a heterogeneous condition and may occur in young, otherwise healthy individuals but also in older patients with cardiovascular comorbidities. It is thought that symptoms occur because of excessive venous pooling (causing a drop in cardiac output) or adrenergic hypersensitivity (resulting in cerebral vasoconstriction or acute rise in cardiac afterload). Since our patient had a marked response to an alpha-blocking agent, we think baroreflex hypersensitivity is the most likely cause of her complaints. Though syncope is probably rare, OHT should be regarded as a possible explanation of orthostatic symptoms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa479","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T06:33:59Z","timestamp":1607927639000},"source":"Crossref","is-referenced-by-count":2,"title":["Too much of a good thing: a case report of traumatic drop attacks and syncope due to orthostatic hypertension"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8618-2858","authenticated-orcid":false,"given":"Martin B","family":"von Bartheld","sequence":"first","affiliation":[{"name":"Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5525-804X","authenticated-orcid":false,"given":"Mari\u00eblle G J","family":"Duffels","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Noord West Ziekenhuis Groep, Post Office Box 501, 1800 AM Alkmaar, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Louis","family":"Handoko","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,12]]},"reference":[{"key":"2021062103193600700_ytaa479-B1","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.ihj.2013.06.023","article-title":"Orthostatic hypertension: recognizing an underappreciated clinical condition","volume":"65","author":"Chhabra","year":"2013","journal-title":"Indian Heart J"},{"key":"2021062103193600700_ytaa479-B2","doi-asserted-by":"crossref","first-page":"2102","DOI":"10.1016\/j.clinph.2015.12.017","article-title":"Orthostatic hypertension: an underestimated cause of orthostatic intolerance","volume":"127","author":"Lee","year":"2016","journal-title":"Clin Neurophysiol"},{"key":"2021062103193600700_ytaa479-B3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1291\/hypres.23.119","article-title":"Contribution of cardiovascular hypersensitivity to orthostatic hypertension and the extreme dipper phenomenon","volume":"23","author":"Moriguchi","year":"2000","journal-title":"Hypertens Res"},{"key":"2021062103193600700_ytaa479-B4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s10286-015-0328-4","article-title":"Orthostatic hypotension and orthostatic hypertension in American veterans","volume":"26","author":"Wecht","year":"2016","journal-title":"Clin Auton Res"},{"key":"2021062103193600700_ytaa479-B5","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1038\/ncpneph0228","article-title":"Orthostatic hypertension: when pressor reflexes overcompensate","volume":"2","author":"Fessel","year":"2006","journal-title":"Nat Rev Nephrol"},{"key":"2021062103193600700_ytaa479-B6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/S0002-9629(15)40482-3","article-title":"Idiopathic orthostatic intolerance and postural tachycardia syndromes","volume":"317","author":"Jacob","year":"1999","journal-title":"Am J Med Sci"},{"key":"2021062103193600700_ytaa479-B7","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0735-1097(02)01923-X","article-title":"U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor","volume":"40","author":"Kario","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2021062103193600700_ytaa479-B8","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/jch.13521","article-title":"Orthostatic hypotension: from pathophysiology to clinical applications and therapeutic considerations","volume":"21","author":"Magkas","year":"2019","journal-title":"J Clin Hypertens"},{"key":"2021062103193600700_ytaa479-B9","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1161\/01.HYP.7.2.196","article-title":"Orthostatic hypertension. 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