Idiopathic Orthostatic Hypotension

The records of 29 patients with chronic idiopathic orthostatic hypotension (IOH) were reviewed and compared with records of 11 patients with a similar syndrome who had diabetes mellitus. Fifteen patients with IOH had significant central nervous system findings consisting of extrapyramidal defects, paresthesia, sphincter disturbances, pyramidal tract signs, and impotence, confirming the presence of a degenerative neurological disease in these patients. Diagnosis was made when there was the simultaneous occurrence of dizziness and syncope with a decline in standing blood pressure of 30/20 mm Hg. Treatment consisted of the use of physical measures to increase venous return, and the administration of vasopressor agents such as ephedrine. When such therapy was ineffective, fludrocortisone acetate was used and resulted in marked improvement in five patients.