Document Detail


Management approaches to hypertension in autonomic failure.
MedLine Citation:
PMID:  22801444     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Supine hypertension is a common finding in autonomic failure that can worsen orthostatic hypotension and predispose to end-organ damage. This review focuses on nonpharmacologic and pharmacologic approaches to manage hypertension in these patients in the face of disabling orthostatic hypotension.
RECENT FINDINGS: The hypertension of autonomic failure can be driven by sympathetic-dependent or independent mechanisms, contingent on the site of autonomic lesions. Management of supine hypertension should include simple nonpharmacologic approaches including avoiding the supine position during the daytime and sleeping in a head-up tilt position at night. Most patients, however, require pharmacologic treatment. Several antihypertensive therapies lower nighttime pressure in autonomic failure, but none improve nocturnal volume depletion or morning orthostatic tolerance. Regardless, treatment may still be beneficial in some patients but must be decided on an individual basis. Blood pressure monitoring is helpful in this regard, as well as titration of doses, as these patients are hypersensitive to depressor agents due to loss of baroreceptor reflexes.
SUMMARY: Autonomic failure provides a unique opportunity to study blood pressure regulation independent of autonomic influences. Understanding mechanisms driving supine hypertension will have important implications for the treatment of autonomic failure and will improve our knowledge of cardiovascular regulation in other populations, including essential hypertension and elderly hypertensive individuals with comorbid orthostatic hypotension.
Authors:
Amy C Arnold; Italo Biaggioni
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  21     ISSN:  1473-6543     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-09     Completed Date:  2013-01-03     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  481-5     Citation Subset:  IM    
Affiliation:
Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-6602, USA.
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MeSH Terms
Descriptor/Qualifier:
Autonomic Nervous System Diseases / complications,  therapy*
Blood Pressure / drug effects
Humans
Hypertension / complications,  therapy*
Supine Position / physiology
Vasodilator Agents / therapeutic use
Grant Support
ID/Acronym/Agency:
HL 056693-16/HL/NHLBI NIH HHS; P01 HL056693/HL/NHLBI NIH HHS; R01 HL067232/HL/NHLBI NIH HHS; U54NS065736-03/NS/NINDS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS; UL1 UL1 TR000445//PHS HHS
Chemical
Reg. No./Substance:
0/Vasodilator Agents
Comments/Corrections

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