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The patient with supine hypertension and orthostatic hypotension: a clinical dilemma

¹ Department of Internal Medicine A, Bnai-Zion Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
² Department of Rheumatology, Bnai-Zion Medical Center and Rappaport Faculty of Medicine

Correspondence to:
Correspondence to:
Professor J E Naschitz
Department of Internal Medicine A, Bnai-Zion Medical Center, Haifa 31048, PO Box 4940, Israel; Naschitz{at}tx.technion.ac.il

Coexistent supine hypertension and orthostatic hypotension (SH-OH) pose a particular therapeutic dilemma, as treatment of one aspect of the condition may worsen the other. Studies of SH-OH are to be found by and large on patients with autonomic nervous disorders as well as patients with chronic arterial hypertension. In medical practice, however, the aetiologies and clinical presentation of the syndrome seem to be more varied. In the most typical cases the diagnosis is straightforward and the responsible mechanism evident. In those patients with mild or non-specific symptoms, the diagnosis is more demanding and the investigation may benefit from results of the tilt test, bedside autonomic tests as well as haemodynamic assessment. Discrete patterns of SH-OH may be recognisable. This review focuses on the management of the patient with coexistent SH-OH.

Abbreviations: HR, heart rate; BP, blood pressure; SH, supine hypertension; OH, orthostatic hypotensin; MAP, mean arterial blood pressure; HUTT, head up tilt test

Keywords: arterial hypertension; postural hypotension; orthostatic hypotension; autonomic nervous; tilt test