Hypertension in orthostatic hypotension and autonomic dysfunction.
Disabling orthostatic hypotension dominates the clinical picture of autonomic failure. Nonetheless, severe supine hypertension is observed in about 50% of patients. In patients with multiple system atrophy (Shy-Drager syndrome), supine hypertension is explained by residual sympathetic tone because it can be eliminated with the ganglionic blocker trimethaphan. The cause of hypertension in patients with pure autonomic failure is not known and its understanding may be relevant to essential hypertension. Supine hypertension complicates the treatment of these patients but can be managed by overnight administration of antihypertensive medications.
Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, 1500 21st Avenue South, Suite 3500, Vanderbilt University, Nashville, TN 37212, USA. italo.biaggioni@mcmail.vanderbilt.edu
Italo
I
Biaggioni
Rose Marie
RM
Robertson
D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D011187:Posture / Q000502:physiology; D012791:Shy-Drager Syndrome / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy