Editing Multiple system atrophy (section)

===Avoidance of postural hypotension===
One particularly serious problem, the [[Orthostatic hypotension|drop in blood pressure upon standing up]] (with risk of [[Syncope (medicine)|fainting]] and thus injury from falling), often responds to [[fludrocortisone]], a synthetic [[mineralocorticoid]].<ref name="MayoMSA" /><ref name=":2">{{cite journal | vauthors = Palma JA, Kaufmann H | title = Management of Orthostatic Hypotension | language = en-US | journal = Continuum | volume = 26 | issue = 1 | pages = 154–177 | date = February 2020 | pmid = 31996627 | pmc = 7339914 | doi = 10.1212/CON.0000000000000816 }}</ref> Another common drug treatment is the [[alpha-agonist]] [[midodrine]].<ref name=MayoMSA>[https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153 Multiple system atrophy (MSA)] ''mayoclinic.org'', accessed 20 May 2018</ref>

Non-drug treatments include "head-up tilt" (elevating the head of the whole bed by about 10 degrees), salt tablets or increasing salt in the diet, generous intake of fluids, and pressure (elastic) stockings. Avoidance of triggers of low blood pressure, such as hot weather, [[alcohol (drug)|alcohol]], and dehydration, are crucial.<ref name=":2" /> The patient can be taught to move and transfer from sitting to standing slowly to decrease risk of falls and limit the effect of [[postural hypotension]].<ref name="Hardy"/> Instruction in ankle pumping helps to return blood in the legs to the [[systemic circulation]].<ref name=Hardy /> Other preventative measures are raising the head of the bed by 8&nbsp;in (20.3&nbsp;cm), and the use of compression stockings and abdominal binders.<ref name="pmid10331752"/>

====Supine hypertension====

In addition to orthostatic hypotension, supine hypertension, where the BP is excessively high lying down, is a frequent problem in multiple system atrophy. Treatment of one symptom can easily aggravate the other, and supine hypertension in such patients has been linked to the same cardiovascular complications as [[essential hypertension]].<ref>{{Cite journal |last1=Palma |first1=Jose-Alberto |last2=Redel-Traub |first2=Gabriel |last3=Porciuncula |first3=Angelo |last4=Samaniego-Toro |first4=Daniela |last5=Millar Vernetti |first5=Patricio |last6=Lui |first6=Yvonne W. |last7=Norcliffe-Kaufmann |first7=Lucy |last8=Kaufmann |first8=Horacio |date=June 2020 |title=The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension |journal=Parkinsonism & Related Disorders |language=en |volume=75 |issue=75 |pages=97–104 |doi=10.1016/j.parkreldis.2020.04.011 |pmc=7415666 |pmid=32516630}}</ref>