Table 1
Medications used in supine hypertension-orthostatic hypotension.
Source publication
Supine hypertension–orthostatic hypotension (SH/OH) is a form of autonomic dysfunction characterized by hypertension when patients are supine and a clinically significant drop in blood pressure when they assume an upright posture. Treatment of this group of patients can be very challenging. In this review we attempt to outline the pathophysiology o...
Context in source publication
Context 1
... an analogous manner we will tolerate supine blood pressures as high as 160-170 mmHg in occasional patients if this proves effective in mitigating severe symptoms and preventing potentially disastrous falls from occurring. To control extreme supine hypertension we often employ alpha-2 agonists such as clonidine, angiotensin receptor blockers, and combined alpha/beta blockers such as labetalol ( Table 1). The drug pyridostigmine is often quite helpful in preventing supine OH without worsen- ing SH. ...
Similar publications
Aims:
Orthostatic hypotension (OH) is a cardinal sign of autonomic dysfunction and a common co-morbidity in heart failure (HF). The role of autonomic dysfunction in the development of structural cardiac anomalies in HF patients has not been sufficiently explored. We aimed to assess relations between orthostatic blood pressure (BP) responses during...
Citations
... On a physiopathological level, OH/SH syndrome may refer to a condition in which sympathetic outflow is inhibited due to a lack of norepinephrine release from postganglionic neurons, especially when standing. As the body is unable to generate a sufficient sympathetic response to support the upright position, OH would eventually manifest [2,8]. These factors, along with deficient baroreflex function, increased blood volume, inappropriate natriuresis, and residual sympathetic output in the presence of hypersensitive postsynaptic adrenergic receptors, may lead to SH. ...
... In this approach, autonomic dysfunction is a significant risk factor to OH/SH syndrome [9]. "Long-term hypertension leads to desensitization of the baroreceptor reflex, which might also contribute to the pathogenesis of OH/SH syndrome" [2]. ...
... "Patients with OH because of autonomic failure (primary or secondary) may at times develop supine hypertension, which could be a result of the medications used for the treatment of OH" [2]. ...
Orthostatic hypotension (OH) and supine hypertension (SH) are two cardiovascular symptoms of autonomic failure that frequently coexist in the same patient. Clinicians are faced with a dilemma because aggressive orthostatic intolerance treatment can exacerbate supine hypertension, and vice versa for supine hypertension management. The objective of our article is to provide a better framework for the clinical evaluation, the right choice of therapeutic options and the improvement of the quality of life of patients with OH-SH syndrome. For these reasons, we report three observations, whose etiologies, clinical presentation, and treatment are different, namely diabetes, multiple system atrophy type C (MSA) and Parkinson's disease.
... Patients with autonomic failure often experience both neurogenic OH and severe nocturnal supine hypertension. 14,53,54 This is a clinical dilemma for clinicians because they must balance the risk of chronic high BP with the risk of falls and increased morbidity associated with OH. 53 In these cases, fludrocortisone should be limited and using evening short-acting antihypertensive agents may be considered. However, the long-term cardiovascular risk associated with supine hypertension is not well known, and the decision to treat should be tailored to individual patient needs. ...
... Patients with autonomic failure often experience both neurogenic OH and severe nocturnal supine hypertension. 14,53,54 This is a clinical dilemma for clinicians because they must balance the risk of chronic high BP with the risk of falls and increased morbidity associated with OH. 53 In these cases, fludrocortisone should be limited and using evening short-acting antihypertensive agents may be considered. However, the long-term cardiovascular risk associated with supine hypertension is not well known, and the decision to treat should be tailored to individual patient needs. ...
Orthostatic hypotension (OH) is common in older people and is associated with a range of adverse outcomes. Although age‐related changes like decreased baroreflex sensitivity make older people prone to OH, medications are often a contributor. Diagnosis of OH can be challenging in older people, because the condition may present with atypical or non‐specific symptoms, such as visual disturbances, shortness of breath, mental fluctuation. Non‐pharmacological management is often a starting point for OH treatment. Fludrocortisone and midodrine remain the most studied drugs for pharmacological management, but newer agents are being tested. In this review we present the current evidence for existing and emerging treatments for OH and address the management of supine hypertension associated with the treatment of OH in patients with autonomic failure. In the management of OH, it is imperative that treatment is tailored to the individual, rather than focusing on attaining an arbitrary blood pressure target.
... prescripción de tratamiento para la hipotensión ortostática, lo cual como ya fue mencionado en una naturaleza dosis dependiente produce como efecto secundario hipertensión arterial supina, hasta en un 50% en algunos estudios). Finalmente, podría ser necesario tener que aceptar cierto nivel de hipertensión supina con el fin de mantener la tolerancia ortostática, ya que la meta del tratamiento es disminuir los síntomas, deambular y no precisamente ser normotenso, además no se han precisado niveles de presión arterial específicos meta 4,9,10,11,21,22 . ...
... Además de las opciones terapéuticas no basadas en el uso de drogas, farmacológicamente el uso de antihipertensivos de acción corta titulados (por ejemplo, captopril e hidralazina) pueden ser utilizados en pacientes con hipertensión arterial supina sostenida, aunque siempre hay que valorar el riesgo beneficio en cuanto a caídas y síncopes, en especial en pacientes con fallas autonómicas. Otras opciones antihipertensivas son el propanolol, la clonidina y la nifedipina 4,9,22,23 . ...
El sistema nervioso está dividido en un sistema nervioso central, el sistema nervioso periférico y el sistema nervioso autonómico. Este sistema autónomo cumple funciones claves en la homeostasis, la adaptación y otras múltiples funciones autoregulatorias. El sistema nervioso autonómico a su vez se clasifica en una división simpática y otra parasimpática, ambas conformadas por una neurona pregangliónica y una posgangliónica. Centros a nivel central regulan las dos divisiones. Los trastornos del sistema nervioso autonómico se pueden manifestar de múltiples maneras, y se clasifican respectivamente en estructurales y funcionales según tengan o no lesiones anatómicamente reconocibles. La hipertensión arterial supina se caracteriza por una presión arterial elevada en dicha posición y si bien es cierto no se ha logrado documentar un daño a órgano blanco de la misma severidad como en la hipertensión arterial crónica, su importancia radica en que es común en pacientes con desórdenes autonómicos y aún más si estos reciben tratamiento por hipotensión ortostática. El tratamiento de la hipertensión arterial supina radica en una serie de medidas no farmacológicas y farmacológicas que tienen el objetivo de sopesar el riesgo de caídas, síncopes y tener tolerancia ortostática contra el posible daño a órgano blanco producido por los niveles elevados de la presión arterial.
