Arterial hypertension with orthostatic hypotension

Czech version

Authors: B. Krahulec; Z. Bartošová
Authors‘ workplace: II. interná klinika Lekárskej fakulty UK a UN Bratislava, Slovenská republika, prednosta prof. MU Dr. Andrej Dukát, CSc., FESC
Published in: Vnitř Lék 2010; 56(9): 951-954
Category: 60th Birthday - Andrej Dukat MD, Csc., FESC

Overview

Arterial hypertension (AH) with orthostatic hypotension (OH) is quite important clinical problem, present especially in older age and in various forms of autonomic nervous system (ANS) failure. ANS damage may be primary, or secondary, most offen in diabetes mellitus. In older age OH occurrence is about 30% and postprandial hypotension is also possible. Various antihypertensive drugs, also tricyclic antidepressants, α₁‑adrenergic receptors antagonists and diuretics may provoke OH. Diagnostic value has simple screening bedside orthostatic test, respectively head up tilt table test and cardiovascular reflex tests. Therapy is non‑medicamentous with enough fluids, compression of legs and higher head and neck position in the night. AH with OH can be treated with short‑ acting antihypertensive drugs, eventually with transdermal nitroglycerin. OH can be treated with clonidine, midodrine, fludrocortisone or β₁‑blocker.

Key words:
orthostatic hypotension – autonomic failure – arterial hypertension

Sources

1. Naschitz JE, Slobodin G, Elias N et al. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J 2006; 82: 246– 253.

2. Lu CC, Tung CS, Jordan J et al. Autonomic cardiovascular control: Lessons from autonomic disorders. J Med Sci 2003; 23: 243– 248.

3. Deegan BM, O’Connor M, Donnely T et al. Lyons orthostatic hypotension: a new classification system. Europace 2007; 9: 937– 941.

4. Kronenberg MW, Forman MB, Onrot Jet al. Enhanced left ventricular contractibility in autonomic failure: assessment using pressure‑volume relations. J Am Coll Cardiol 1990; 15: 1334– 1342.

5. Sáez T, Suárez C, Sierra MJ et al. Orthostatic hypotension in the aged and its association with antihypertensive treatment. Med Clin 2000; 114: 525– 529.

6. Goldstein DS, Pechnik S, Holmes C et al. Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension 2003; 42: 136– 142.

7. The Consensus Committee of the American Autonomic Society the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension pure autonomic failure multiple systemic atrophy. Neurology 1996; 46: 1470.

8. Naschitz JE, Mussafia‑ Priselac R, Kovalev Y et al. Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head‑ up tilt. J Hum Hypertens 2006; 20: 157– 162.

9. Smit AA, Halliwill JR, Low PA et al. Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol 1999; 519: 1– 10.

10. Rutan GH, Hermanson, B, Bild DE et al. Orthostatic hypotension in older adults: the Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension 1992; 19: 508– 519.

11. Kearney F, Moore A. Treatment of combined hypertension and orthostatic hypotension in older adults: more questions than answers still remain. Expert Rev Cardiovasc Ther 2009; 7: 557– 560.

12. Robertson D. The pathophysiology and diagnosis of orthostatic hypotension. Clin Auton Res 2008; 18 (Suppl 1): 2– 7.

13. Cooke J, Carew S, O’Connor M et al. Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension. QJM 2009; 102: 335– 339.

14. Low PA. Prevalence of orthostatic hypotension. Clin Auton Res 2008; 18 (Suppl 1): 8– 13.

15. Krahulec B. Význam a možnosti vyšetrovania autonómneho nervového systému u pacientov s diabetes mellitus. Časť 1. Noninvas Cardiol 1995; 4: 154– 164.

16. Krahulec B. Možnosti využitia kardiovaskulárnych reflexov v diagnostike porúch autonómneho nervového systému u nediabetikov. Časť 2. Noninvas Cardiol 1995; 4: 165– 173.

17. Sartori M, Pesina AC, Semplicini A. Orthostatic hypotension and supine hypertension in primary autonomic failure. Hypertension 2005; 45: e18– e19.

18. Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens 2002; 4: 139– 145.

19. Shibao C, Gamboa A, Abraham R et al. Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure. Hypertension 2006; 47: 522– 526.

20. Eguchi K, Pickering TG, Ishikawa J et al. Severe orthostatic hypotension with diabetic autonomic neuropathy successfully treated with a b1‑blocker: a case report. J Hum Hypertens 2006; 20: 801– 803.