Generic placeholder image

Current Cardiology Reviews

Author(s): Aamir Ahmed, Mohammed Ruzieh*, Shaffi Kanjwal and Khalil Kanjwal

DOI: 10.2174/1573403X15666190617095032

DownloadDownload PDF Flyer Cite As
Syndrome of Supine Hypertension with Orthostatic Hypotension: Pathophysiology and Clinical Approach

Page: [48 - 54] Pages: 7

  • * (Excluding Mailing and Handling)

Abstract

This article is intended to provide guidance and clinical considerations for physicians managing patients suffering from supine hypertension with orthostatic hypotension, referred to as “SH-OH”. We review the normal physiologic response to orthostasis, focusing on the appropriate changes to autonomic output in this state. Autonomic failure is discussed with a generalized overview of the disease and examination of specific syndromes that help shed light on the pathophysiology of SH-OH. The goal of this review is to provide a better framework for clinical evaluation of these patients, review treatment options, and ultimately work toward achieving a better quality of life for patients afflicted with this disease.

Keywords: Orthostatic hypotension, supine hypertension, autonomic failure, dysautonomia, blood pressure, orthostatic posture.

Graphical Abstract

[1]
Kanjwal K, George A, Figueredo VM, Grubb BP. Orthostatic hypotension: definition, diagnosis and management. J Cardiovasc Med (Hagerstown) 2015; 16(2): 75-81.
[http://dx.doi.org/10.2459/01.JCM.0000446386.01100.35] [PMID: 24933201]
[2]
Naschitz JE, Slobodin G, Elias N, Rosner I. The patient with supine hypertension and orthostatic hypotension: A clinical dilemma. Postgrad Med J 2006; 82(966): 246-53.
[http://dx.doi.org/10.1136/pgmj.2005.037457] [PMID: 16597811]
[3]
Mader SL, Josephson KR, Rubenstein LZ. Low prevalence of postural hypotension among community-dwelling elderly. JAMA 1987; 258(11): 1511-4.
[http://dx.doi.org/10.1001/jama.1987.03400110093033] [PMID: 3625952]
[4]
Applegate WB, Davis BR, Black HR, Smith WM, Miller ST, Burlando AJ. Prevalence of postural hypotension at baseline in the Systolic Hypertension in the Elderly Program (SHEP) cohort. J Am Geriatr Soc 1991; 39(11): 1057-64.
[http://dx.doi.org/10.1111/j.1532-5415.1991.tb02869.x] [PMID: 1753042]
[5]
Lagi A, Rossi A, Comelli A, Rosati E, Cencetti S. FADOI Hypertension Group.Postural hypotension in hypertensive patients. Blood Press 2003; 12(5-6): 340-4.
[http://dx.doi.org/10.1080/08037050310022423] [PMID: 14763667]
[6]
Rutan GH, Hermanson B, Bild DE, Kittner SJ, LaBaw F, Tell GS. CHS Collaborative Research Group.Orthostatic hypotension in older adults. The Cardiovascular Health Study. Hypertension 1992; 19(6 Pt 1): 508-19.
[http://dx.doi.org/10.1161/01.HYP.19.6.508] [PMID: 1592445]
[7]
Lamarre-Cliche M. Orthostatic hypotension and supine hypertension in the patient with autonomic failure. Canadian J General Intern Med 2014; 9: 91-5.
[http://dx.doi.org/10.19144/1911-1606.9.3.2]
[8]
Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens (Greenwich) 2002; 4(2): 139-45.
[http://dx.doi.org/10.1111/j.1524-6175.2001.00516.x] [PMID: 11927799]
[9]
Ruzieh M, Batizy L, Dasa O, Oostra C, Grubb B. The role of autoantibodies in the syndromes of orthostatic intolerance: A systematic review. Scand Cardiovasc J 2017; 51(5): 243-7.
[http://dx.doi.org/10.1080/14017431.2017.1355068] [PMID: 28738696]
[10]
Arnold AC, Biaggioni I. Management approaches to hypertension in autonomic failure. Curr Opin Nephrol Hypertens 2012; 21(5): 481-5.
[http://dx.doi.org/10.1097/MNH.0b013e328356c52f] [PMID: 22801444]
[11]
Shannon J, Jordan J, Costa F, Robertson RM, Biaggioni I. The hypertension of autonomic failure and its treatment. Hypertension 1997; 30(5): 1062-7.
[http://dx.doi.org/10.1161/01.HYP.30.5.1062] [PMID: 9369256]
[12]
Biaggioni I, Robertson RM. Hypertension in orthostatic hypotension and autonomic dysfunction. Cardiol Clin 2002; 20(2): 291-301. vii.
[http://dx.doi.org/10.1016/S0733-8651(01)00005-4] [PMID: 12119802]
[13]
Garland EM, Gamboa A, Okamoto L, et al. Renal impairment of pure autonomic failure Hypertension (Dallas, Tex: 1979) 2009; 54: 1057-61
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.136853]
[14]
Vagaonescu TD, Saadia D, Tuhrim S, Phillips RA, Kaufmann H. Hypertensive cardiovascular damage in patients with primary autonomic failure. Lancet 2000; 355(9205): 725-6.
[http://dx.doi.org/10.1016/S0140-6736(99)05320-9] [PMID: 10703810]
[15]
Jordan J, Shannon JR, Pohar B, et al. Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure. J Am Soc Nephrol 1999; 10(1): 35-42.
[PMID: 9890307]
[16]
Wenning GK, Stefanova N. Recent developments in multiple system atrophy. J Neurol 2009; 256(11): 1791-808.
[http://dx.doi.org/10.1007/s00415-009-5173-8] [PMID: 19471850]
[17]
Goldstein DS, Holmes C, Sharabi Y, Brentzel S, Eisenhofer G. Plasma levels of catechols and metanephrines in neurogenic orthostatic hypotension. Neurology 2003; 60(8): 1327-32.
[http://dx.doi.org/10.1212/01.WNL.0000058766.46428.F3] [PMID: 12707437]
[18]
Goldstein DS, Holmes C, Cannon RO III, Eisenhofer G, Kopin IJ. Sympathetic cardioneuropathy in dysautonomias. N Engl J Med 1997; 336(10): 696-702.
[http://dx.doi.org/10.1056/NEJM199703063361004] [PMID: 9041100]
[19]
Hague K, Lento P, Morgello S, Caro S, Kaufmann H. The distribution of Lewy bodies in pure autonomic failure: autopsy findings and review of the literature. Acta Neuropathol 1997; 94(2): 192-6.
[http://dx.doi.org/10.1007/s004010050693] [PMID: 9255396]
[20]
Kaufmann H, Hague K, Perl D. Accumulation of alpha-synuclein in autonomic nerves in pure autonomic failure. Neurology 2001; 56(7): 980-1.
[http://dx.doi.org/10.1212/WNL.56.7.980] [PMID: 11294945]
[21]
Smit AAJ, Halliwill JR, Low PA, Wieling W. Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol 1999; 519(Pt 1): 1-10.
[http://dx.doi.org/10.1111/j.1469-7793.1999.0001o.x] [PMID: 10432334]
[22]
Goldstein DS, Pechnik S, Holmes C, Eldadah B, Sharabi Y. Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension 2003; 42(2): 136-42.
[http://dx.doi.org/10.1161/01.HYP.0000081216.11623.C3] [PMID: 12835329]
[23]
Shannon JR, Jordan J, Diedrich A, et al. Sympathetically mediated hypertension in autonomic failure. Circulation 2000; 101(23): 2710-5.
[http://dx.doi.org/10.1161/01.CIR.101.23.2710] [PMID: 10851208]
[24]
Shibao C, Raj SR, Gamboa A, et al. Norepinephrine transporter blockade with atomoxetine induces hypertension in patients with impaired autonomic function. Hypertension 2007; 50(1): 47-53.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.089961] [PMID: 17515448]
[25]
Kanda T, Tomimitsu H, Yokota T, Ohkoshi N, Hayashi M, Mizusawa H. Unmyelinated nerve fibers in sural nerve in pure autonomic failure. Ann Neurol 1998; 43(2): 267-71.
[http://dx.doi.org/10.1002/ana.410430220] [PMID: 9485071]
[26]
Kronenberg MW, Forman MB, Onrot J, Robertson D. Enhanced left ventricular contractility in autonomic failure: Assessment using pressure-volume relations. J Am Coll Cardiol 1990; 15(6): 1334-42.
[http://dx.doi.org/10.1016/S0735-1097(10)80023-3] [PMID: 2158505]
[27]
Biaggioni I, Garcia F, Inagami T, Haile V. Hyporeninemic normoaldosteronism in severe autonomic failure. J Clin Endocrinol Metab 1993; 76(3): 580-6.
[PMID: 7680352]
[28]
Jacob G, Shannon JR, Black B, et al. Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia. Circulation 1997; 96(2): 575-80.
[http://dx.doi.org/10.1161/01.CIR.96.2.575] [PMID: 9244228]
[29]
Ruzieh M, Dasa O, Pacenta A, Karabin B, Grubb B. Droxidopa in the treatment of postural orthostatic tachycardia syndrome. Am J Ther 2017; 24(2): e157-61.
[http://dx.doi.org/10.1097/MJT.0000000000000468] [PMID: 27563801]
[30]
Kanjwal K, Karabin B, Sheikh M, et al. Pyridostigmine in the treatment of postural orthostatic tachycardia: A single-center experience. Pacing Clin Electrophysiol 2011; 34(6): 750-5.
[http://dx.doi.org/10.1111/j.1540-8159.2011.03047.x] [PMID: 21410722]
[31]
Ishitobi M, Haginoya K, Kitamura T, Munakata M, Yokoyama H, Iinuma K. Acute dysautonomia: Complete recovery after two courses of IVIg. Brain Dev 2004; 26(8): 542-4.
[http://dx.doi.org/10.1016/j.braindev.2004.02.012] [PMID: 15533658]
[32]
Gibbons CH, Vernino SA, Freeman R. Combined immunomodulatory therapy in autoimmune autonomic ganglionopathy. Arch Neurol 2008; 65(2): 213-7.
[http://dx.doi.org/10.1001/archneurol.2007.60] [PMID: 18268189]