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Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension.
Curr Neurol Neurosci Rep. 2021 03 09; 21(4):18.CN

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.

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Authors+Show Affiliations

Isaacson SH
Parkinson's Disease and Movement Disorders Center of Boca Raton, 951 NW 13th Street, Bldg. 5-E, Boca Raton, FL, USA. isaacson@ParkinsonsCenter.org.
Dashtipour K
Division of Movement Disorders, Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Mehdirad AA
Wright State University, Dayton VA Medical Center, Dayton, OH, USA.
Peltier AC
Department of Neurology and Medicine, Vanderbilt University, Nashville, TN, USA.

MeSH

Autonomic Nervous System DiseasesBlood PressureDroxidopaHumansHypertensionHypotension, Orthostatic

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

33687577

Citation

Isaacson, Stuart H., et al. "Management Strategies for Comorbid Supine Hypertension in Patients With Neurogenic Orthostatic Hypotension." Current Neurology and Neuroscience Reports, vol. 21, no. 4, 2021, p. 18.
Isaacson SH, Dashtipour K, Mehdirad AA, et al. Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension. Curr Neurol Neurosci Rep. 2021;21(4):18.
Isaacson, S. H., Dashtipour, K., Mehdirad, A. A., & Peltier, A. C. (2021). Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension. Current Neurology and Neuroscience Reports, 21(4), 18. https://doi.org/10.1007/s11910-021-01104-3
Isaacson SH, et al. Management Strategies for Comorbid Supine Hypertension in Patients With Neurogenic Orthostatic Hypotension. Curr Neurol Neurosci Rep. 2021 03 9;21(4):18. PubMed PMID: 33687577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension. AU - Isaacson,Stuart H, AU - Dashtipour,Khashayar, AU - Mehdirad,Ali A, AU - Peltier,Amanda C, Y1 - 2021/03/09/ PY - 2021/01/21/accepted PY - 2021/3/9/entrez PY - 2021/3/10/pubmed PY - 2021/4/28/medline KW - Autonomic dysfunction KW - Blood pressure dysregulation KW - Droxidopa KW - Fludrocortisone KW - Midodrine KW - Pyridostigmine KW - Variable blood pressure SP - 18 EP - 18 JF - Current neurology and neuroscience reports JO - Curr Neurol Neurosci Rep VL - 21 IS - 4 N2 - 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. SN - 1534-6293 UR - https://www.unboundmedicine.com/medline/citation/33687577/Management_Strategies_for_Comorbid_Supine_Hypertension_in_Patients_with_Neurogenic_Orthostatic_Hypotension_ DB - PRIME DP - Unbound Medicine ER -