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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

Jordan, 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, Italos

doi: 10.1097/HJH.0000000000002078

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.

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:

Abbreviation: BP, blood pressure

Received 18 December, 2018

Revised 31 January, 2019

Accepted 1 February, 2019

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