Atrial Tachypacing in the Treatment of a Patient with Primary Orthostatic Hypotension

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Abstract
PRIMARY orthostatic hypotension is an inexorably progressive condition characterized by symptoms and signs of sympathetic-nervous-system degeneration.1 A striking clinical feature of this disorder is severe orthostatic hypotension, often without compensatory tachycardia. To date, therapy for this condition has been less than satisfactory.2 3 4 Case ReportRecently, we saw a 77-year-old man with an eight-year history of progressive, incapacitating primary orthostatic hypotension that had been unresponsive to traditional therapies (mineralocorticoids, sympathomimetic amines, elastic stockings, and an antigravity suit). Neurologic examination revealed no abnormality of the central nervous system. The heart rate remained fixed at 72 beats per minute despite marked orthostatic reduction . . .