In patients with orthostatic hypotension, fludrocortisone is an established early treatment option. When it fails to deliver adequate symptom relief or a meaningful rise in standing blood pressure, a structured next-line approach is required. This protocol addresses that clinical situation directly.
Fludrocortisone (a mineralocorticoid) was the previous treatment. Escalation to this protocol is indicated when it did not achieve the goal of reduced symptoms with higher blood pressure. That failure signals the need to consider additional or alternative interventions.
The protocol covers additional and less frequently used interventions — both pharmacological and non-pharmacological — that may be employed alone or in combination for patients whose orthostatic symptoms persist. The full structured regimen, including the complete list of options and the clinical algorithm, is available below.
DOI: 10.1093/eurheartj/ehy037
Additional and less frequently used treatments, alone or in combination, include desmopressin in patients with nocturnal polyuria, octreotide in postprandial hypotension, erythropoietin in anaemia, pyridostigmine, the use of walking sticks, frequent small meals, and the judicious exercise of leg and abdominal muscles, especially swimming.
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