[Orthostatic hypotension and supine hypertension: a practical guide to diagnosis and management]

G Ital Cardiol (Rome). 2021 Jan;22(1):42-52. doi: 10.1714/3502.34882.
[Article in Italian]

Abstract

Orthostatic hypotension is a medical condition potentially debilitating and associated with a negative prognosis. It is paramount for cardiologists to recognize it, mostly for the following reasons: it is a predictive factor for cardiovascular events, it may cause syncope, and it is frequently associated with supine hypertension. Orthostatic hypotension may be secondary to neurogenic etiology (baroreflex dysfunction) or non-neurogenic etiology (dehydration or medication-related). Although laboratory tests exploring the autonomic nervous system are required for a detailed etiologic diagnosis, medical history and a sphygmomanometer can be sufficient for diagnosis. Therapeutic management of orthostatic hypotension is challenging, mostly because of the association in half of the cases with supine hypertension. Treatment should be a compromise between anti-hypotensive and anti-hypertensive measures with one overcoming the other based on the hour of the day. Non-pharmacological therapies, regarded as avoidance of precipitating factors and physical and dietary interventions, as well as chronic treatment revision, have a pivotal role.In this review we will discuss, in a pragmatic manner, about epidemiology, etiology, clinical aspects and diagnosis of orthostatic hypotension. Moreover, we will discuss about prognosis and management of orthostatic hypotension and supine hypertension.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Humans
  • Hypertension* / drug therapy
  • Hypertension* / therapy
  • Hypotension, Orthostatic* / diagnosis
  • Hypotension, Orthostatic* / etiology
  • Hypotension, Orthostatic* / therapy
  • Prognosis
  • Supine Position

Substances

  • Antihypertensive Agents