Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension

Item Type:	Article
Title:	Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension
Creators Name:	Jordan, J. and Biaggioni, I.
Abstract:	Orthostatic hypotension is seen in various medical conditions. It can be secondary to medications or volume depletion. It can also be due to autonomic neuropathy secondary to other diseases, such as diabetes mellitus, or to primary degenerative processes of the autonomic nervous system. Orthostatic hypotension dominates the clinical picture of patients suffering from autonomic failure. Paradoxically, about one half of these patients also suffer from supine hypertension, which induces pressure natriuresis, worsening orthostatic hypotension. It also complicates the treatment of orthostatic hypotension. Supine hypertension is mediated by an increase in peripheral vascular resistance. This is due to residual sympathetic tone in patients with multiple system atrophy (Shy-Drager syndrome), but the cause is not known in patients with pure autonomic failure, who have increased vascular resistance despite very low levels or plasma norepinephrine and renin activity. The recent observation that patients with supine hypertension develop left ventricular hypertrophy suggests they should be treated. During the day, avoiding the supine position is often all that is required. Short-acting vasodilators (e.g., transdermal nitroglycerin) can be used during the night.
Keywords:	Antihypertensive Agents, Hypertension, Patient Education As Topic, Shy-Drager Syndrome, Sleep, Supine Position, Vasodilator Agents
Source:	Journal of Clinical Hypertension
ISSN:	1524-6175
Publisher:	Wiley-Blackwell
Volume:	4
Number:	2
Page Range:	139-145
Date:	March 2002
Official Publication:	https://doi.org/10.1111/j.1524-6175.2001.00516.x
PubMed:	View item in PubMed

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