<unk>  treatment involves using multiple methods in combination to counteract cardiovascular dysfunction, address symptoms, and simultaneously address any associated disorders. For most patients, water intake should be increased, especially after waking, in order to expand blood volume (reducing hypovolemia). Eight to ten cups of water daily are recommended. Increasing salt intake, by adding salt to food, taking salt tablets, or drinking sports drinks and other electrolyte solutions is an effective way to raise blood pressure by helping the body retain water. Different physicians recommend different amounts of sodium to their patients. Combining these techniques with gradual physical training enhances their effect. In some cases, when increasing oral fluids and salt intake is not enough, intravenous saline or the drug desmopressin is used to help increase fluid retention. Large meals worsen symptoms for some people. These people may benefit from eating small meals frequently throughout the day instead. Alcohol and food high in carbohydrates can also exacerbate symptoms of<unk>  hypotension. Excessive consumption of caffeine beverages should be avoided, because they can promote urine production (leading to fluid loss) and consequently hypovolemia. Exposure to extreme heat may also aggravate symptoms. Aggravating factors : Exertion (81%) : Continued standing (80%) : Heat (79%) : After meals (42%) Prolonged physical inactivity can worsen the symptoms of<unk> . Techniques that increase a person's capacity for exercise, such as endurance training or graded exercise therapy, can relieve symptoms for some patients. Aerobic exercise performed for 20 minutes a day, three times a week, is sometimes recommended for patients who can tolerate it. Exercise may have the immediate effect of worsening<unk> , especially after a meal or on a hot day. In these cases, it may be easier to exercise in a semi-reclined position, such as riding a recumbent bicycle, rowing, or swimming. When changing to an upright posture, finishing a meal, or concluding exercise, a sustained hand grip can briefly raise the blood pressure, possibly reducing symptoms. Compression garments can also be of benefit by constricting blood pressures with external body pressure. Medication If nonpharmacological methods are ineffective, medication may be necessary. Medications used may include beta blockers, pyridostigmine, midodrine, or fludrocortisone. As of 2013, no medication has been approved by the U.S. Food and Drug Administration to treat<unk> , but a variety are used off-label. Their efficacy has not yet been examined in long-term randomized controlled trials. Fludrocortisone may be used to enhance sodium retention and blood volume, which may be beneficial not only by augmenting sympathetically-mediated vasoconstriction, but also because a large subset of<unk>  patients appear to have low absolute blood volume. While people with<unk>  typically have normal or even elevated arterial blood pressure, the neuropathic form of<unk>  is presumed to constitute a selective sympathetic venous denervation. In these patients the selective Alpha-1 adrenergic receptor agonist midodrine may increase venous return, enhance stroke volume, and improve symptoms. Midodrine should only be taken during the daylight hours as it may promote supine hypertension. Sinus node blocker Ivabradine can successfully restrain heart rate in<unk>  without affecting blood pressure, demonstrated in approximately 60% of people with<unk>  treated in an open-label trial of ivabradine experienced symptom improvement. Pyridostigmine has been reported to restrain heart rate and improve chronic symptoms in approximately half of people. The selective alpha-1 agonist phenylephrine has been used successfully to enhance venous return and stroke volume in some people with<unk> . However, this medication may be hampered by poor oral bioavailability. Pharmacologic treatments for<unk><unk>  syndrome<unk>  subtypes Therapeutic action Goal Drug(s) Neuropathic<unk>  Alpha-1 adrenergic receptor agonist Constrict the peripheral blood vessels aiding venous return. Midodrine Splanchnic–mesenteric vasoconstriction Splanchnic vasoconstriction Octreotide Hypovolemic<unk>  Synthetic mineralocorticoid Forces the body to retain salt. Increase blood volume Fludrocortisone (Florinef) Vasopressin receptor agonist Helps retain water, Increase blood volume Desmopressin (DDAVP) Hyperadrenergic<unk>  beta-blockers (Non-Selective) Decrease sympathetic tone and heart rate. Propranolol (Inderal) beta-blockers (Selective) Metoprolol (Toprol), Bisoprolol Selective sinus node blockade Directly reducing<unk> . Ivabradine alpha-2 adrenergic receptor agonist Decreases blood pressure and sympathetic nerve traffic. Clonidine, Methyldopa Anticholinesterase inhibitors Splanchnic vasoconstriction. Increase blood pressure. Pyridostigmine Other (Refractory<unk>  Psychostimulant Improve cognitive symptoms (Brain Fog) Modafinil Central nervous system stimulant Tighten blood vessels. Increases alertness and improves brain fog. Methylphenidate (Ritalin, Concerta) Direct and indirect α1-adrenoreceptor agonist. Increased blood flows Ephedrine and pseudoephedrine Norepinephrine precursor Improve blood vessel contraction Droxidopa (Northera) Alpha-2 adrenergic antagonist Increase blood pressure Yohimbine
Postural orthostatic tachycardia syndrome
Da Costa's syndrome  Da Costa's syndrome  1
Heat syncope
Laughter-induced syncope
Vasoplegic syndrome
Reflex syncope
Permissive hypotension
Postanesthetic shivering