{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:10:16Z","timestamp":1756375816282,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100013327","name":"Lundbeck","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013327","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,25]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A 62-year-old man presented with a 2-year history of syncope, collapse and fluctuating blood pressure (BP). His medications included midodrine (10\u2009mg, three times per day) and fludrocortisone (0.1\u2009mg, two times per day), but neither treatment afforded symptomatic relief. Autonomic testing was performed. Head-up tilt table testing revealed a supine BP of 112\/68\u2009mm Hg (heart rate, 74 beats per minute (bpm)) after 6\u2009min, which dropped to 76\/60\u2009mm Hg (83 bpm) within 2\u2009min of 80\u00b0 head-up tilt. Findings from a heart rate with deep breathing test and a Valsalva test were consistent with autonomic dysfunction. The patient was diagnosed with neurogenic orthostatic hypotension and treated with droxidopa (100\u2009mg, two times per day; titrated to 100\u2009mg, one time per day). After initiating treatment with droxidopa, the patient no longer reported losing consciousness on standing and experienced improvement in activities of daily living. These improvements were maintained through 1\u2009year of follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2018-228423","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T05:55:20Z","timestamp":1566366920000},"page":"e228423","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Utility of autonomic testing for the efficient diagnosis and effective pharmacological management of neurogenic orthostatic hypotension"],"prefix":"10.1136","volume":"12","author":[{"given":"Sami bin","family":"Alam","sequence":"first","affiliation":[{"name":"The Heartbeat Clinic, McKinney, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waiel","family":"Almardini","sequence":"additional","affiliation":[{"name":"The Heartbeat Clinic, McKinney, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amer","family":"Suleman","sequence":"additional","affiliation":[{"name":"The Heartbeat Clinic, McKinney, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,20]]},"reference":[{"key":"2025082802454566000_12.8.e228423.1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.120980"},{"key":"2025082802454566000_12.8.e228423.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2014.05.011"},{"key":"2025082802454566000_12.8.e228423.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.003"},{"key":"2025082802454566000_12.8.e228423.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.03.029"},{"key":"2025082802454566000_12.8.e228423.5","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-011-0119-5"},{"key":"2025082802454566000_12.8.e228423.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp074189"},{"key":"2025082802454566000_12.8.e228423.7","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/jch.12062","article-title":"ASH position paper: evaluation and treatment of orthostatic hypotension","volume":"15","author":"Shibao","year":"2013","journal-title":"J Clin Hypertens"},{"key":"2025082802454566000_12.8.e228423.8","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1007\/s00415-016-8375-x","article-title":"The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension","volume":"264","author":"Gibbons","year":"2017","journal-title":"J Neurol"},{"key":"2025082802454566000_12.8.e228423.9","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/14656566.2018.1543404","article-title":"Chemical pharmacotherapy for the treatment of orthostatic hypotension","volume":"20","author":"Cheshire","year":"2019","journal-title":"Expert Opin Pharmacother"},{"key":"2025082802454566000_12.8.e228423.10","first-page":"439","article-title":"A prospective study of the association between orthostatic hypotension and falls: definition matters","volume":"46","author":"McDonald","year":"2017","journal-title":"Age Ageing"},{"key":"2025082802454566000_12.8.e228423.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)00425-8"},{"key":"2025082802454566000_12.8.e228423.12","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC Guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"2025082802454566000_12.8.e228423.13","unstructured":"NORTHERA \u00ae (droxidopa). Full Prescribing Information. Deerfield, IL: Lundbeck NA Ltd, 2017."},{"key":"2025082802454566000_12.8.e228423.14","unstructured":"ProAmatine \u00ae (midodrine hydrochloride). Full Prescribing Information. Lexington, MA: Shire US Inc, 2017."},{"key":"2025082802454566000_12.8.e228423.15","first-page":"117","article-title":"Progressively invalidating orthostatic hypotension: A common symptom for a challenging diagnosis","volume":"21","author":"Pelusi","year":"2016","journal-title":"J Res Med Sci"},{"key":"2025082802454566000_12.8.e228423.16","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.hrcr.2018.09.011","article-title":"Is it bradycardia or something else causing symptoms?","volume":"4","author":"Olshansky","year":"2018","journal-title":"HeartRhythm Case Rep"},{"key":"2025082802454566000_12.8.e228423.17","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s40119-018-0124-z","article-title":"Treatment of Orthostatic Hypotension Due to Autonomic Dysfunction (Neurogenic Orthostatic Hypotension) in a Patient with Cardiovascular Disease and Parkinson\u2019s Disease","volume":"8","author":"McCullough","year":"2019","journal-title":"Cardiol Ther"},{"key":"2025082802454566000_12.8.e228423.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.05.079"},{"key":"2025082802454566000_12.8.e228423.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7461.336"},{"key":"2025082802454566000_12.8.e228423.20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.15420\/aer.2018.22.2","article-title":"Pacing for vasovagal syncope","volume":"7","author":"Gopinathannair","year":"2018","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2025082802454566000_12.8.e228423.21","doi-asserted-by":"crossref","first-page":"31iii","DOI":"10.1136\/jnnp.74.suppl_3.iii31","article-title":"Autonomic diseases: clinical features and laboratory evaluation","volume":"74","author":"Mathias","year":"2003","journal-title":"J Neurol Neurosurg Psychiatry"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:45:56Z","timestamp":1756374356000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,20]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bcr-2018-228423"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228423","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}