The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension

Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension

“…20 Supine hypertension can affect renovascular function, sodium and water reabsorption, and renin-angiotensin release (e.g., elevated angiotensin II levels in patients with autonomic failure and supine hypertension versus healthy controls 26,27 ) and has been associated with increased markers of end-organ damage, greater incidence of cardiovascular events, and increased mortality in patients with autonomic failure. 21 Other cardiovascular complications associated with OH/ nOH include atrial fibrillation, atrial ectopy, and cardiac remodeling, including increased left ventricular mass and other ventricular and atrial changes (Table 1). 14−19 In patients with autonomic failure, increased left ventricular mass similar to hypertensive patients has been observed (both significantly higher than healthy controls).…”

Management of coexistent neurogenic orthostatic hypotension and supine hypertension

“…Because of the symptomatic burden and fall risk associated with nOH, management of this condition usually takes priority to reduce the patient's symptoms and improve daily function; nevertheless, the risks of uncontrolled SH must also be considered. Although there are limited data specific to the hypertensive risk in patients with nOH, studies of patients with autonomic failure suggest that SH is associated with potentially poor outcomes including cardiovascular damage (left ventricular hypertrophy), decreased renal function (lower estimated glomerular filtration rate and higher creatinine), and an increased risk of cardiovascular morbidity and mortality . Further, SH increases nocturnal pressure natriuresis, causing nocturia and volume loss overnight, which can lead to worsened nOH symptoms the following morning .…”

Characterization of the changes in supine blood pressure with long‐term use of droxidopa in patients with neurogenic orthostatic hypotension

“…Because of autonomic and baroreceptor dysfunction, patients with nOH can also experience supine hypertension 1,3 . Although supine hypertension differs from essential hypertension in that the BP elevation in supine hypertension is episodic (ie, not constant as in essential hypertension) and associated with being in the supine position, 1 supine hypertension may increase the risk of cardiovascular, cerebrovascular, and renal morbidity 5‐7 . Supine hypertension and nOH are hemodynamically opposed and, as such, pharmacologic treatments for nOH that increase standing BP may result in or exacerbate supine hypertension 1,3,8 …”