Occasional sphygmomanometric readings are not an effective way of evaluating the effect of treatment in patients with hypoadrenergic orthostatic hypotension. A novel non-invasive portable device (Portapres) was used to monitor 24 hour continuous finger blood pressure before and during chronic volume expansion in a 66 year old woman with severe orthostatic hypotension. In both conditions pressures while she was standing were lowest in the morning. Her tolerance to standing and walking increased during the day and, as a consequence of a higher upright mean blood pressure, was improved after treatment. Mean blood pressure during sleep was increased after treatment. Continuous 24 hour non-invasive finger blood pressure monitoring is a promising technique for the evaluation of the effect of treatment in patients with autonomic failure. It provides information about situations in daily life that cannot be obtained by laboratory tests or conventional sphygmomanometric measurements.
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