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

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 includ...

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Autores principales: Isaacson, Stuart H., Dashtipour, Khashayar, Mehdirad, Ali A., Peltier, Amanda C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943503/
https://www.ncbi.nlm.nih.gov/pubmed/33687577
http://dx.doi.org/10.1007/s11910-021-01104-3
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author Isaacson, Stuart H.
Dashtipour, Khashayar
Mehdirad, Ali A.
Peltier, Amanda C.
author_facet Isaacson, Stuart H.
Dashtipour, Khashayar
Mehdirad, Ali A.
Peltier, Amanda C.
author_sort Isaacson, Stuart H.
collection PubMed
description 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. SUMMARY: 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.
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spelling pubmed-79435032021-04-05 Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension Isaacson, Stuart H. Dashtipour, Khashayar Mehdirad, Ali A. Peltier, Amanda C. Curr Neurol Neurosci Rep Autonomic Dysfunction (L.H. Weimer, Section Editor) 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. SUMMARY: 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. Springer US 2021-03-09 2021 /pmc/articles/PMC7943503/ /pubmed/33687577 http://dx.doi.org/10.1007/s11910-021-01104-3 Text en © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Autonomic Dysfunction (L.H. Weimer, Section Editor)
Isaacson, Stuart H.
Dashtipour, Khashayar
Mehdirad, Ali A.
Peltier, Amanda C.
Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
title Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
title_full Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
title_fullStr Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
title_full_unstemmed Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
title_short Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
title_sort management strategies for comorbid supine hypertension in patients with neurogenic orthostatic hypotension
topic Autonomic Dysfunction (L.H. Weimer, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943503/
https://www.ncbi.nlm.nih.gov/pubmed/33687577
http://dx.doi.org/10.1007/s11910-021-01104-3
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