Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar 9;21(4):18.
doi: 10.1007/s11910-021-01104-3.

Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension

Stuart H Isaacson  1 , Khashayar Dashtipour  2 , Ali A Mehdirad  3 , Amanda C Peltier  4
Affiliations
Review

Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension

Stuart H Isaacson et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: In autonomic failure, neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are interrelated conditions characterized by postural blood pressure (BP) dysregulation. nOH results in a sustained BP drop upon standing, which can lead to symptoms that include lightheadedness, orthostatic dizziness, presyncope, and syncope. nSH is characterized by elevated BP when supine and, although often asymptomatic, may increase long-term cardiovascular and cerebrovascular risk. This article reviews the pathophysiology and clinical characteristics of nOH and nSH, and describes the management of patients with both nOH and nSH.

Recent findings: Pressor medications required to treat the symptoms of nOH also increase the risk of nSH. Because nOH and nSH are hemodynamically opposed, therapies to treat one condition may exacerbate the other. The management of patients with nOH who also have nSH can be challenging and requires an individualized approach to balance the short- and long-term risks associated with these conditions. Approaches to manage neurogenic BP dysregulation include nonpharmacologic approaches and pharmacologic treatments. A stepwise treatment approach is presented to help guide neurologists in managing patients with both nOH and nSH.

Keywords: Autonomic dysfunction; Blood pressure dysregulation; Droxidopa; Fludrocortisone; Midodrine; Pyridostigmine; Variable blood pressure.

PubMed Disclaimer

Conflict of interest statement

SH Isaacson has served as a consultant and received honoraria for CME, research grants, and/or promotional speaker on behalf of AbbVie, Acadia, Acorda, Adamas, Addex, Affiris, Alexva, Allergan, Amarantus, Amneal, Axovant, Benevolent, Biogen, Britannia, Cadent, Cala, Cerecor, Cipla, Eli Lilly, Enterin, GE Healthcare, Global Kinetics, Impax, Impel, Intec Pharma, Ipsen, Jazz, Kyowa, Lundbeck, Merz, Michael J. Fox Foundation, Mitsubishi Tanabe, Neuralym, Neurocrine, Neuroderm, Parkinson Study Group, Pharma2B, Prilenia, Promentis, Revance, Roche, Sanofi, Sunovion, Sun Pharma, Teva, Theravance, UCB, US World Meds, and Zambon. K Dashtipour has served as an advisor, consultant, or speaker for AbbVie, Acadia, Acorda, Adamas, Allergan, Amneal, Ipsen, Kyowa Kirin, Lundbeck, Neurocrine, Revance, Sunovion, Teva, and US WorldMeds. AA Mehdirad has served as a speaker for Lundbeck, Pfizer, and Bristol-Myers Squibb. AC Peltier has received fees for consultancy, honoraria, and/or travel/lodging from Lundbeck, Alnylam and Akcea, CSL Behring, and Daiichi Sankyo Inc.

Figures

Fig 1
Fig 1
Stepwise treatment approach for managing nSH in patients with nOH [••, 26, 59]. BP blood pressure; HR heart rate; nOH neurogenic orthostatic hypotension; nSH neurogenic supine hypertension; SBP systolic blood pressure. *Recommended based on the clinical experience of the authors
See this image and copyright information in PMC

References

    1. Jordan J, Fanciulli A, Tank J, Calandra-Buonaura G, Cheshire WP, Cortelli P, et al. Management of supine hypertension in patients with neurogenic orthostatic hypotension: scientific statement of the American Autonomic Society, European Federation of Autonomic Societies, and the European Society of Hypertension. J Hypertens. 2019;37(8):1541–1546. doi: 10.1097/hjh.0000000000002078. - DOI - PubMed
    1. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72. doi: 10.1007/s10286-011-0119-5. - DOI - PubMed
    1. Freeman R, Abuzinadah AR, Gibbons C, Jones P, Miglis MG, Sinn DI. Orthostatic hypotension: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72(11):1294–1309. doi: 10.1016/j.jacc.2018.05.079. - DOI - PubMed
    1. Nwazue VC, Raj SR. Confounders of vasovagal syncope: orthostatic hypotension. Cardiol Clin. 2013;31(1):89–100. - PMC - PubMed
    1. Celedonio JE, Arnold AC, Dupont WD, Ramirez CE, Diedrich A, Okamoto LE, Raj SR, Robertson D, Peltier AC, Biaggioni I, Shibao CA. Residual sympathetic tone is associated with reduced insulin sensitivity in patients with autonomic failure. Clin Auton Res. 2015;25(5):309–315. - PMC - PubMed

Publication types

MeSH terms