The initial feature in men is impotence
The symptom that usually brings patients to the physician is orthostatic hypotension, or a fall in blood pressure with standing. The orthostatic hypotension may be described as unsteadiness, dizziness, or faintness upon standing. It is worse in the morning, after meals or exercise, or in hot weather.
Patients also complain of pain in the neck or back of the head, relieved by lying down.
Loss of ability to sweat as much as the body did in the past.
Changes in urination including nocturia (the need to urinate during the night), urinary hesitancy (difficulty starting or maintaining a urinary stream), urgency, dribbling, and occasional incontinence. This can lead to an increased chance of urinary tract infections.
The orthostatic hypotension is usually accompanied by supine hypertension, or increased blood pressure while lying, even when the patient is on no medications to raise blood pressure.
It is noteworthy that patients with PAF do not usually have fevers as high as healthy subjects; nevertheless, any fever will significantly lower their blood pressure and consequently decrease their functional capacity.
Patients with PAF have a generally good outlook; many live for 20 years or more after the onset of their disease. The most common cause of death in these patients is pulmonary embolus or recurrent infection.