CONSENSUS DOCUMENTManagement 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 HypertensionJordan, Jensa,b,c; Fanciulli, Alessandrad; Tank, Jensa,b,c; Calandra-Buonaura, Giovannae,f; Cheshire, William P.g; Cortelli, Pietroe,f; Eschlboeck, Sabined; Grassi, Guidoh,i; Hilz, Max J.j,k; Kaufmann, Horaciol; Lahrmann, Heinzm; Mancia, Giuseppen; Mayer, Gerto; Norcliffe-Kaufmann, Lucyl; Pavy-Le Traon, Annep,q; Raj, Satish R.r,s; Robertson, Davids; Rocha, Isabelt; Reuter, Hannesc,u,v; Struhal, Walterw; Thijs, Roland D.x,y; Tsioufis, Konstantinos P.z; Gert van Dijk, J.y; Wenning, Gregor K.d; Biaggioni, ItalosAuthor Information aInstitute of Aerospace Medicine, German Aerospace Center (DLR) bChair of Aerospace Medicine, University of Cologne cUniversity Hypertension Center, University of Cologne, Cologne, Germany dDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria eDepartment of Biomedical and Neuromotor Sciences, University of Bologna fIRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy gDepartment of Neurology, Mayo Clinic, Jacksonville, Florida, USA hClinica Medica, University of Milano-Bicocca iIstituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni, Milano, Italy jDepartment of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany kDepartment of Neurology, Icahn School of Medicine at Mount Sinai lDepartment of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA mPrivate Practice, Vienna, Austria nCentro di Fisiologia Clinica ed Ipertensione, Milano, Italy oDepartment of Internal Medicine IV, Innsbruck Medical University, Innsbruck, Austria pDepartment of Neurology, French Reference Centre for Multiple System Atrophy, University Hospital of Toulouse qUMR INSERM 1048, Toulouse, France rDepartment of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada sDivision of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee tFaculty of Medicine, Institute of Physiology, University of Lisbon, Lisbon, Portugal uDepartment of Internal Medicine and Cardiology, Evangelisches Klinikum Köln vDepartment III of Internal Medicine, Cardiac Center, University Hospital of Cologne, Cologne, Germany wDepartment of Neurology, Karl Landsteiner University of Health Sciences, Site Tulln, Tulln, Austria xStichting Epilepsie Instellingen Nederland, Heemstede yDepartment of Neurology, Leiden University Medical Centre, Leiden, The Netherlands z1st Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece Correspondence to Jens Jordan, MD, Institute of Aerospace Medicine, Linder Hoehe, 51147 Cologne, Germany. Tel: +49 2203 601 3115; fax: +49 2203 69 5211; e-mail: [email protected] Abbreviation: BP, blood pressure Received 18 December, 2018 Revised 31 January, 2019 Accepted 1 February, 2019 Journal of Hypertension: August 2019 - Volume 37 - Issue 8 - p 1541-1546 doi: 10.1097/HJH.0000000000002078 Buy Metrics Abstract Supine hypertension commonly occurs in patients with neurogenic orthostatic hypotension due to autonomic failure. Supine hypertension promotes nocturnal sodium excretion and orthostatic hypotension, thus, interfering with quality of life. Perusal of the literature on essential hypertension and smaller scale investigations in autonomic failure patients also suggest that supine hypertension may predispose to cardiovascular and renal disease. These reasons provide a rationale for treating supine hypertension. Yet, treatment of supine hypertension, be it through nonpharmacological or pharmacological approaches, may exacerbate orthostatic hypotension when patients get up during the night. Fall-related complications may occur. More research is needed to define the magnitude of the deleterious effects of supine hypertension on cardiovascular, cerebrovascular, and renal morbidity and mortality. Integration of more precise cardiovascular risk assessment, efficacy, and safety data, and the prognosis of the underlying condition causing autonomic failure is required for individualized management recommendations. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.