Raising awareness for cardiovascular autonomic dysfunction: the 2023 European Society of Hypertension guidelines revisited

Abstract

The clinical guidelines of the European Society of Hypertension (ESH) are a resource used not only by hypertension specialists but also by general physicians, internists, and other medical specialties. While the focus remains on management of hypertensive disorders, for the first time, the new 2023 guidelines include recommendations for diagnosis and management of autonomic disorders, including autonomic failure and (afferent) baroreflex failure among others [1]. This is a welcomed addition and one that will raise awareness of cardiovascular autonomic diseases among non-autonomic specialists. In this editorial, we will give an overview on the areas that are covered by the new guidelines, relevant to patients with autonomic disorders.Because blood pressure and heart rate are tightly regulated through baroreflex adjustments of sympathetic and parasympathetic efferent nerves, patients with autonomic disorders often present with cardiovascular signs and symptoms. The most obvious consequence of autonomic cardiovascular disease is an inability to regulate blood pressure with standing, which makes orthostatic blood pressure and heart rate measurements a useful clinical screening test. The 2023 ESH guidelines recommend the measurement of orthostatic vitals as a screening tool in persons older than 65 years and in patients with treated arterial hypertension, diabetes mellitus, neurodegenerative disorders, or with orthostatic symptoms [1]. The recommendation is to measure blood pressure after 1 and 3 min standing to detect orthostatic * Jens Jordan