Key result
New criteria define supine hypertension in nOH as SBP ≥140 mmHg despite unproven long-term treatment benefits.
Why the study?
Patients with severe orthostatic hypotension due to autonomic failure may experience supine hypertension, but internationally recognized diagnostic criteria were lacking until recently.
This review highlights the new consensus definition of supine hypertension in patients with neurogenic orthostatic hypotension and emphasizes the need for large clinical trials to prove the benefits of treatment.
New supine hypertension definition in neurogenic orthostatic hypotension warrants clinical awareness; leaves open whether treatment confers long-term benefit.
PURPOSE OF REVIEW: Patients with severe orthostatic hypotension due to autonomic failure may be hypertensive in the supine position. Until recently, there were no internationally recognized diagnostic criteria for supine hypertension. This review covers diagnostic criteria, mechanisms, and management of supine hypertension in autonomic failure patients. RECENT FINDINGS: Recently, an international consensus group defined supine hypertension in patients with neurogenic orthostatic hypotension as brachial SBP at least 140 mmHg and/or DBP at least 90 mmHg while supine. Using these criteria, a large proportion of patients with orthostatic hypotension is diagnosed with supine hypertension. Recent research supports the concept that the hypertension can be mediated through residual sympathetic nervous system function and independently from sympathetic activity, for example via mineralocorticoid receptor activation. SUMMARY: The clear definition of supine hypertension is an important step that will hopefully foster clinical research in this area. Supine hypertension promotes renal sodium excretion, thus, worsening orthostatic hypotension the next morning. Supine hypertension may promote cardiovascular and renal disease. Yet, long-term benefits of treating supine hypertension be it through non pharmacological or pharmacological means have not been proven by sufficiently large clinical trials.
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Jordan et al. (2019) conducted a review in Supine hypertension in patients with orthostatic hypotension. Supine hypertension in neurogenic orthostatic hypotension is now defined as brachial SBP ≥140 mmHg and/or DBP ≥90 mmHg, though long-term benefits of treatment remain unproven by large trials.
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