PMID: 16533484Mar 15, 2006Paper

Management of hypertension in the setting of autonomic dysfunction

Current Treatment Options in Cardiovascular Medicine
Cyndya ShibaoI Biaggioni

Abstract

Supine hypertension is a common finding in patients with autonomic failure; it is associated with end-organ damage and produces nighttime pressure diuresis with worsening of orthostatic hypotension. During the daytime, it is best treated by avoiding the supine posture. At night, simple measures such as raising the head of the bed by 6 to 9 inches can be effective, but most patients require pharmacologic treatment. Transdermal nitroglycerin (0.1 to 0.2 mg/h) or nifedipine (30 mg, orally) has proved to be effective. Hydralazine and minoxidil are usually less effective but may be useful in a given patient. One key therapeutic concept is the hypersensitivity of these patients to depressor agents, requiring a careful titration of the doses on an individual basis. For those patients with proven residual sympathetic tone, as in multiple system atrophy, central sympatholytics such as clonidine may provide an alternative.

Associated Clinical Trials

References

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Citations

May 13, 2011·Journal of Neurology·Tjalf ZiemssenBirgit Herting
Jul 19, 2011·Journal of the Neurological Sciences·Yehonatan Sharabi, David S Goldstein
Dec 25, 2010·Therapeutic Advances in Neurological Disorders·Tjalf Ziemssen, Heinz Reichmann
Dec 25, 2016·Pharmacological Reviews·Italo Biaggioni
Feb 17, 2009·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Svatopluk BinderJan Halek
Jul 28, 2020·Journal of Parkinson's Disease·Alessandra FanciulliGregor K Wenning

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