Abstract
Patients with cardiovascular autonomic failure (AF) may suffer from neurogenic supine
hypertension (nSH), defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic
blood pressure ≥90 mmHg, after 5 min of rest in the supine position, combined with
neurogenic orthostatic hypotension (nOH) in approximately 50% of the cases.
nSH may be the manifestation of central or peripheral autonomic lesions.
Long-term risks are hypothesized with SH, including renal dysfunction, left ventricular
hypertrophy, cerebrovascular disease and cognitive impairment. Yet, large longitudinal
studies investigating long-term outcomes of nSH are lacking.
In clinical practice, nSH should be investigated in patients with nOH. Office screening
should be performed measuring supine BP immediately after lying down and 5 min later,
combined with BP measurement on active or passive standing. Home BP recordings performed
by patients themselves may also be useful, while 24 h-Ambulatory Blood Pressure Monitoring
(ABPM) may allow for detection of nocturnal hypertension and confirm the diagnosis.
Current expert recommendations suggest treatment interventions if SBP exceeds 160–180 mmHg.
Non-pharmacological strategies represent the first-line treatment approach and include
head-up sleeping, avoiding supine position during the daytime, and having a snack
before bedtime to lower supine BP using post-prandial hypotension. Pharmacological
treatments may be considered if severe nSH persists. Short-acting antihypertensive
medications administered at bedtime are preferably used in order to selectively lower
supine BP and reduce pressure diuresis without worsening daytime hypotension.
Keywords
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Article Info
Publication History
Published online: May 14, 2022
Accepted:
May 10,
2022
Received in revised form:
March 30,
2022
Received:
January 14,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
