scholarly journals Normalization of Blood Pressure in a Patient With Severe Orthostatic Hypotension and Supine Hypertension Using Clonidine

Hypertension ◽  
2001 ◽  
Vol 37 (6) ◽  
Author(s):  
Rajesh Brahmbhatt ◽  
Paul Baggaley ◽  
Bernard Hockings
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Supine Hypertension

603 CHALLENGES IN THE MANAGEMENT OF SEVERE ORTHOSTATIC HYPOTENSION ASSOCIATED WITH SUPINE HYPERTENSION IN A PATIENT WITH AUTONOMIC DYSFUNCTION ON BACKGROUND OF NASOPHARYNGEAL CARCINOMA AND TYPE II DIABETES MELLITUS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
Q M N Rachel ◽  
K Mamun ◽  
M H Nguyen
Keyword(s):  
Blood Pressure ◽  
Nasopharyngeal Carcinoma ◽  
Orthostatic Hypotension ◽  
Carotid Sinus ◽  
Blood Pressure Monitoring ◽  
Pharmacological Interventions ◽  
Supine Hypertension ◽  
Neck Irradiation ◽  
Baroreflex Failure

Abstract Introduction Combined chemotherapy and radiotherapy increases long term survival in patients with nasopharyngeal carcinoma. However, radiotherapy of the carotid sinus or brain stem can evolve labile hypertension and orthostatic intolerance from chronic baroreflex failure. Diabetes would also cause this neuropathy. Management of patients with Supine hypertension-Orthostatic hypotension can be very challenging. Methods A case report was done on a 71-year-old man with metastatic nasopharyngeal carcinoma status post radiation therapy who was admitted with severe supine hypertension-orthostatic hypotension. Patient was managed with both non-pharmacological and pharmacological methods, and monitored for postural symptoms, complications of severe supine hypertension—which has been linked to left ventricular hypertrophy and kidney dysfunction, and placed on 24 hour ambulatory blood pressure monitoring to aid in management so as to prevent hypertension induced organ damage. Results This review outlines the pathophysiology of Supine hypertension-Orthostatic hypotension, treatment complications and potential management strategies recommendations for this group of patients. It revealed the benefit of having a 24 hour ambulatory blood pressure monitoring, which provides insight on the timing and magnitude of an individual’s blood pressure fluctuations throughout the day so as to further guide management. Conclusion Chronic baroreflex failure is a late sequela of neck irradiation for naso-pharyngeal carcinoma due to accelerated atherosclerosis in the region of the carotid sinus baroreceptor. Treatment goal is achieved with adequate control of pre-syncopal symptoms and prevention of long term complications. Non-pharmacological interventions remain the first line of therapy, followed by pharmacological interventions as necessary. Nonetheless, management of blood pressure in these elderly patients with baroreflex dysfunction remains challenging and should be individualized. Moving forward, a prospective study on the incidence of late onset, iatrogenic baroreflex failure as a late complication of neck irradiation and its particular relationship to carotid arterial rigidity should be conducted to increase awareness, timely diagnosis and management of the condition among physicians.

Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials

2018 ◽  
Vol 52 (12) ◽  
pp. 1182-1194 ◽  
Author(s):  
Jack J. Chen ◽  
Yi Han ◽  
Jonathan Tang ◽  
Ivan Portillo ◽  
Robert A. Hauser ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Fixed Effects ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Mixed Treatment Comparison ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
Treatment Comparison ◽  
Mixed Treatment

Background: The comparative effects of droxidopa and midodrine on standing systolic blood pressure (sSBP) and risk of supine hypertension in patients with neurogenic orthostatic hypotension (NOH) are unknown. Objective: To perform a Bayesian mixed-treatment comparison meta-analysis of droxidopa and midodrine in the treatment of NOH. Methods: The PubMed, CENTRAL, and EMBASE databases were searched up to November 16, 2016. Study selection consisted of randomized trials comparing droxidopa or midodrine with placebo and reporting on changes in sSBP and supine hypertension events. Data were pooled to perform a comparison among interventions in a Bayesian fixed-effects model using vague priors and Markov chain Monte Carlo simulation with Gibbs sampling, calculating pooled mean changes in sSBP and risk ratios (RRs) for supine hypertension with associated 95% credible intervals (CrIs). Results: Six studies (4 administering droxidopa and 2 administering midodrine) enrolling a total of 783 patients were included for analysis. The mean change from baseline in sSBP was significantly greater for both drugs when compared with placebo (droxidopa 6.2 mm Hg [95% CrI = 2.4-10] and midodrine 17 mm Hg [95% CrI = 11.4-23]). Comparative analysis revealed a significant credible difference between droxidopa and midodrine. The RR for supine hypertension was significantly greater for midodrine, but not droxidopa, when compared with placebo (droxidopa RR = 1.4 [95% CrI = 0.7-2.7] and midodrine RR = 5.1 [95% CrI = 1.6-24]). Conclusion and Relevance: In patients with NOH, both droxidopa and midodrine significantly increase sSBP, the latter to a greater extent. However, midodrine, but not droxidopa, significantly increases risk of supine hypertension.

scholarly journals Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA)

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252212
Author(s):  
Orna A. Donoghue ◽  
Matthew D. L. O’Connell ◽  
Robert Bourke ◽  
Rose Anne Kenny
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Important Indicator ◽  
Supine Hypertension ◽  
Risk Of Falls ◽  
Community Dwelling Older Adults

Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) ≥20 mmHg and/or ≥10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.

scholarly journals Paroxysmal Orthostatic Ventricular Tachycardia in a Patient With Supine Hypertension and Orthostatic Hypotension

2020 ◽  
Vol 8 ◽  
pp. 232470962095830
Author(s):  
Khalil Kanjwal ◽  
Shakeel M. Jamal ◽  
David W. McComb ◽  
Majid Mughal ◽  
Asim Kichloo
Keyword(s):  
Blood Pressure ◽  
Ventricular Tachycardia ◽  
Orthostatic Hypotension ◽  
Autonomic Dysfunction ◽  
Treatment Strategies ◽  
Upright Posture ◽  
Supine Hypertension ◽  
Nonsustained Ventricular Tachycardia ◽  
Premature Ventricular Beats ◽  
Orthostatic Hypertension

Supine orthostatic hypertension with orthostatic hypotension is an autonomic dysfunction where the patients present with hypertension when supine and with decrease in blood pressure while bearing an upright posture. We report on a 74-year-old male who was admitted with dizziness and was found to have profound orthostatic hypotension with supine hypertension. The patient also developed orthostatic paroxysmal premature ventricular beats as well as nonsustained ventricular tachycardia. In this report, we attempt to present the possible mechanism of orthostatic ventricular tachycardia in our patient and the overview of the treatment strategies used in management of patients with supine hypertension and orthostatic hypotension.

scholarly journals Dysautonomia

2012 ◽  
Vol 116 (1) ◽  
pp. 205-215 ◽  
Author(s):  
Hossam I. Mustafa ◽  
Joshua P. Fessel ◽  
John Barwise ◽  
John R. Shannon ◽  
Satish R. Raj ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
Orthostatic Hypotension ◽  
Postoperative Care ◽  
Drug Sensitivity ◽  
Autonomic Failure ◽  
Diagnosis And Treatment ◽  
Supine Hypertension ◽  
Crucial Element ◽  
Management Of Care

Severe autonomic failure occurs in approximately 1 in 1,000 people. Such patients are remarkable for the striking and sometimes paradoxic responses they manifest to a variety of physiologic and pharmacologic stimuli. Orthostatic hypotension is often the finding most commonly noted by physicians, but a myriad of additional and less understood findings also occur. These findings include supine hypertension, altered drug sensitivity, hyperresponsiveness of blood pressure to hypo/hyperventilation, sleep apnea, and other neurologic disturbances. In this article the authors will review the clinical pathophysiology that underlies autonomic failure, with a particular emphasis on those aspects most relevant to the care of such patients in the perioperative setting. Strategies used by clinicians in diagnosis and treatment of these patients, and the effect of these interventions on the preoperative, intraoperative, and postoperative care that these patients undergo is a crucial element in the optimized management of care in these patients.

scholarly journals Contrasting Effects of Vasodilators on Blood Pressure and Sodium Balance in the Hypertension of Autonomic Failure

1999 ◽  
Vol 10 (1) ◽  
pp. 35-42 ◽  
Author(s):  
JENS JORDAN ◽  
JOHN R. SHANNON ◽  
BOJAN POHAR ◽  
SACHIN Y. PARANJAPE ◽  
DAVID ROBERTSON ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Sodium Balance ◽  
Orthostatic Tolerance ◽  
Supine Hypertension ◽  
Renal Sodium Handling ◽  
Pressure Natriuresis ◽  
Depressor Effect ◽  
Sodium Handling

Abstract. Supine hypertension, which is very common in patients with autonomic failure, limits the use of pressor agents and induces nighttime natriuresis. In 13 patients with severe orthostatic hypotension due to autonomic failure (7 women, 6 men, 72 ± 3 yr) and supine hypertension, the effect of 30 mg nifedipine (n = 10) and 0.025 to 0.2 mg/h nitroglycerin patch (n = 11) on supine BP, renal sodium handling, and orthostatic tolerance was determined. Medications were given at 8 p.m.; patients stood up at 8 a.m. Nitroglycerin was removed at 6 a.m. Compared with placebo, nifedipine and nitroglycerin decreased systolic BP during the night by a maximum of 37 ± 9 and 36 ± 10 mmHg, respectively (P < 0.01). At 8 a.m., supine systolic BP was 23 ± 7 mmHg lower with nifedipine than with placebo (P < 0.05), but was similar with nitroglycerin and placebo. Sodium excretion during the night was not reduced with nitroglycerin (0.13 ± 0.02 mmol/mg creatinine [Cr] versus 0.15 ± 0.03 mmol/mg Cr with placebo), but it was increased with nifedipine (0.35 ± 0.06 mmol/mg Cr versus 0.13 ± 0.02 mmol/mg Cr with placebo, P < 0.05). Nifedipine but not nitroglycerin worsened orthostatic hypotension in the morning. It is concluded that nifedipine and transdermal nitroglycerin are effective in controlling supine hypertension in patients with autonomic failure. However, nifedipine has a prolonged depressor effect and worsens orthostatic hypotension in the morning. The decrease in pressure natriuresis that would be expected with the substantial decrease in BP obtained with nitroglycerin and nifedipine may be offset by a direct effect of both drugs on renal sodium handling.

scholarly journals Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3075
Author(s):  
Claudia Torino ◽  
Rocco Tripepi ◽  
Maria Carmela Versace ◽  
Antonio Vilasi ◽  
Giovanni Tripepi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Orthostatic Hypotension ◽  
Clinical Epidemiology ◽  
Hemodialysis Patients ◽  
Excess Death ◽  
Death Risk ◽  
Standardized Protocol ◽  
Pressure Changes ◽  
The Impact

Blood pressure changes upon standing reflect a hemodynamic response, which depends on the baroreflex system and euvolemia. Dysautonomia and fluctuations in blood volume are hallmarks in kidney failure requiring replacement therapy. Orthostatic hypotension has been associated with mortality in hemodialysis patients, but neither this relationship nor the impact of changes in blood pressure has been tested in patients on peritoneal dialysis. We investigated both these relationships in a cohort of 137 PD patients. The response to orthostasis was assessed according to a standardized protocol. Twenty-five patients (18%) had systolic orthostatic hypotension, and 17 patients (12%) had diastolic hypotension. The magnitude of systolic and diastolic BP changes was inversely related to the value of the corresponding supine BP component (r = −0.16, p = 0.056 (systolic) and r = −0.25, p = 0.003 (diastolic), respectively). Orthostatic changes in diastolic, but not in systolic, BP were linearly related to the death risk (HR (1 mmHg reduction): 1.04, 95% CI 1.01–1.07, p = 0.006), and this was also true for CV death (HR: 1.08, 95% CI 1.03–1.12, p = 0.001). The strength of this association was not affected by further data adjustment (p ≤ 0.05). These findings suggest that independent of the formal diagnosis of orthostatic hypotension, even minor orthostatic reductions in diastolic BP bear an excess death risk in this population.

Usefulness of Leg-Crossing for Maintaining Blood Pressure in a Sitting Position in Patients with Orthostatic Hypotension—Case Reports

Angiology ◽  
1991 ◽  
Vol 42 (5) ◽  
pp. 421-425 ◽  
Author(s):  
Shuichi Takishita ◽  
Takashi Touma ◽  
Nobuyuki Kawazoe ◽  
Hiromi Muratani ◽  
Koshiro Fukiyama
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Case Reports ◽  
Sitting Position

scholarly journals Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Roman Romero-Ortuno ◽  
Matthew DL O’Connell ◽  
Ciaran Finucane ◽  
Christopher Soraghan ◽  
Chie Wei Fan ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Clinical Management ◽  
Supine Hypertension
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