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Diagnostic and therapeutical management of supine hypertension in autonomic failure

a review of the literature

Vallelonga, Fabrizio; Maule, Simona

doi: 10.1097/HJH.0000000000002008

Supine hypertension is defined as a blood pressure at least 140 mmHg systolic or at least 90 mmHg diastolic in the supine position; supine hypertension is present in over 50% of patients with autonomic failure and orthostatic hypotension, but it is often overlooked. It may be related to antihypotensive drugs, but its presence in untreated patients suggests a neurogenic origin. Supine hypertension is often asymptomatic although it is associated with multiple organ damage. There are no official guidelines on its treatment and long-term benefits have never been proved. The present review is focused on the management of supine hypertension, including nonpharmacological and pharmacological approach. All the tested drugs have been individually revised, focusing on their hypotensive effect and their ability to act on ancillary targets, such as morning orthostatic tolerance or sodium urine excretion. Moreover, the main pathogenic mechanisms and the correct approach to the diagnosis of supine hypertension have been resumed.

Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy

Correspondence to Fabrizio Vallelonga, Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Torino, Italy. Tel: +39 011 633 6959; fax: +39 011 633 6931; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; CCB, calcium-channel blocker; MSA, multiple system atrophy; PAF, pure autonomic failure

Received 29 July, 2018

Accepted 30 October, 2018

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