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(Hypertension. 2005;45:e18.)
© 2005 American Heart Association, Inc.

Hypertension Electronic Pages

Orthostatic Hypotension and Supine Hypertension in Primary Autonomic Failure

Michelangelo Sartori; Achille C. Pessina; Andrea Semplicini

Clinica Medica 4, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
To the Editor:

We read with interest the article of Shibao et al dealing with the treatment options when neurogenic orthostatic hypotension is complicated by supine hypertension.¹

When orthostatic hypotension is caused by central and peripheral nervous system disorders such as primary autonomic failure, the patients report several syncope episodes, and treatment of hypertension is a "dilemma." In the "management of supine hypertension" section, the authors propose a stepwise approach to treat hypertension, including the use of antihypertensive agents in patients with pure autonomic failure (PAF) and multiple system atrophy.

Because it is more important to avoid daytime hypotension than hypertension, we suggest caution in the use of antihypertensive agents. The physician in charge should remember that the decision of starting antihypertensive drugs should not be based on the blood pressure values measured while the patient is lying in bed in the hospital. In case of supine hypertension, laboratory investigation, resting electrocardiography, echocardiography, and ultrasound carotid examination should be performed according to recent guidelines for the management of arterial hypertension.² Moreover, a 24-hour noninvasive ambulatory blood pressure measurement (ABPM) should be included in the clinical assessment because it correlates strictly with target organ damage,^2–3 and it can show the real blood pressure pattern during everyday life.

The documentation of hypertensive target organ damage suggests that one should undergo antihypertensive drug treatment. In patients with PAF, whose life expectancy is only a little reduced,⁴ prevention of cardiovascular events with antihypertensive agents is reasonable, whereas in patients with multiple system atrophy, whose . . . [Full Text of this Article]

Cyndya Shibao; Alfredo Gamboa; André Diedrich; Italo Biaggioni

Division of Clinical Pharmacology, Department of Medicine and Pharmacology, and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, Tennessee