Jin-Woo Park1,2, Luis E Okamoto1, Italo Biaggioni3,4. 1. Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 560A RRB, USA. 2. Department of Neurology, Korea University Medical Center, Seoul, Korea. 3. Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 560A RRB, USA. italo.biaggioni@vumc.org. 4. Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 560A RRB, USA. italo.biaggioni@vumc.org.
Abstract
PURPOSE OF REVIEW: Patients with neurogenic orthostatic hypotension (OH) frequently have hypertension in the supine position (sHTN). We review the controversies surrounding the need and safety of treating sHTN in patients with OH. RECENT FINDINGS: The presence of sHTN complicates the management of OH because treatment of one can worsen the other. New approaches have been developed to treat OH without worsening sHTN by preferentially improving standing blood pressure, such as medications that harness the patient's residual sympathetic tone like pyridostigmine and atomoxetine, and devices such as an automated abdominal binder that targets the inappropriate splanchnic venous pooling causing OH. There is a reluctance to treat sHTN for fear of increasing the risks of falls and syncope associated with OH, thought to be more immediate and dangerous than the late complications of organ damage associated with sHTN. This, however, does not take into account that nighttime sHTN induces natriuresis, volume loss, and begets daytime orthostatic hypotension. It is possible to treat sHTN in ways that reduce the risk of worsening OH. Furthermore, novel approaches, such as the use of local heat can control nighttime sHTN, reduce nocturia, and improve OH. Although continued progress is needed, recent findings offer hope that we can treat nocturnal sHTN and at the same time improve daytime OH, lessening the controversy whether to treat or not sHTN.
PURPOSE OF REVIEW: Patients with neurogenic orthostatic hypotension (OH) frequently have hypertension in the supine position (sHTN). We review the controversies surrounding the need and safety of treating sHTN in patients with OH. RECENT FINDINGS: The presence of sHTN complicates the management of OH because treatment of one can worsen the other. New approaches have been developed to treat OH without worsening sHTN by preferentially improving standing blood pressure, such as medications that harness the patient's residual sympathetic tone like pyridostigmine and atomoxetine, and devices such as an automated abdominal binder that targets the inappropriate splanchnic venous pooling causing OH. There is a reluctance to treat sHTN for fear of increasing the risks of falls and syncope associated with OH, thought to be more immediate and dangerous than the late complications of organ damage associated with sHTN. This, however, does not take into account that nighttime sHTN induces natriuresis, volume loss, and begets daytime orthostatic hypotension. It is possible to treat sHTN in ways that reduce the risk of worsening OH. Furthermore, novel approaches, such as the use of local heat can control nighttime sHTN, reduce nocturia, and improve OH. Although continued progress is needed, recent findings offer hope that we can treat nocturnal sHTN and at the same time improve daytime OH, lessening the controversy whether to treat or not sHTN.
Authors: Luis E Okamoto; Alfredo Gamboa; Cyndya Shibao; Bonnie K Black; André Diedrich; Satish R Raj; David Robertson; Italo Biaggioni Journal: Hypertension Date: 2008-12-01 Impact factor: 10.190
Authors: Luis E Okamoto; Alfredo Gamboa; Cyndya A Shibao; Amy C Arnold; Leena Choi; Bonnie K Black; Satish R Raj; David Robertson; Italo Biaggioni Journal: Hypertension Date: 2014-09-29 Impact factor: 10.190
Authors: D S Goldstein; R J Polinsky; M Garty; D Robertson; R T Brown; I Biaggioni; R Stull; I J Kopin Journal: Ann Neurol Date: 1989-10 Impact factor: 10.422