Supine hypertension as a distinct phenotype of neurogenic orthostatic hypotension with relatively preserved clinical function in Parkinson’s disease

Supine hypertension (SH) frequently co-occurs with neurogenic orthostatic hypotension (nOH) in Parkinson’s disease (PD), yet its clinical characteristics and autonomic status remain unclear. By comparing PD patients with coexisting nOH and SH against those with isolated nOH, we found that the PDOH + SH+ group displayed better cognitive function, lower burden of non-motor symptoms, and a higher quality of life. Notably, while patients with isolated nOH showed significant vagus nerve (VN) atrophy, the VN remained morphologically intact in patients with SH. These findings suggest that the presence of SH in patients with nOH denotes a distinct clinical phenotype of PD. Furthermore, this study provides valuable insights for addressing the therapeutic dilemma of managing PD OH and SH.