What is the name for a condition with hypotension when standing and hypertension when sitting or lying down?

From the Guidelines

The condition characterized by hypotension when standing and hypertension when sitting or lying down is called orthostatic hypertension, sometimes referred to as paradoxical hypertension. This condition is essentially the opposite of the more commonly known orthostatic hypotension. In orthostatic hypertension, blood pressure abnormally increases when a person is in a seated or supine position, rather than when standing, as in orthostatic hypotension. The condition involves autonomic nervous system dysfunction that causes inappropriate vasoconstriction when changing positions.

Key Points

• Management typically includes careful blood pressure monitoring in different positions, lifestyle modifications such as gradual position changes, adequate hydration, and sometimes medications that target the underlying autonomic dysfunction 1.
• These might include alpha-blockers or calcium channel blockers to help regulate blood pressure across positional changes.
• The condition can be particularly challenging to manage because treatments must balance the need to control hypertension in seated/supine positions without worsening hypotension when standing.
• Orthostatic hypertension is less common than orthostatic hypotension but can be equally problematic for patients, causing symptoms like dizziness, falls, and increased cardiovascular risk due to blood pressure fluctuations.
• According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension, postural or orthostatic hypotension is common, present in approximately 10% of all hypertensive adults and up to 50% of older institutionalized adults 1.
• The 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope also provides recommendations for managing orthostatic hypotension, including acute water ingestion, physical counter-pressure maneuvers, compression garments, midodrine, droxidopa, fludrocortisone, and pyridostigmine 1. However, it is essential to note that these guidelines primarily focus on orthostatic hypotension rather than orthostatic hypertension.

Considerations

• When managing orthostatic hypertension, it is crucial to consider the potential risks and benefits of different treatment strategies, including the impact on morbidity, mortality, and quality of life.
• A personalized approach to management, taking into account the individual patient's needs and circumstances, is likely to be the most effective way to improve outcomes. Given the complexity of this condition and the need for careful management, consultation with a healthcare professional is essential to determine the best course of treatment.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Condition Description

The condition described is characterized by hypotension when standing and hypertension when sitting or lying down.

Possible Condition

• This condition can be related to orthostatic hypotension (OH), which is traditionally defined as a fall of ≥20 mmHg in systolic and/or ≥10 mmHg in diastolic blood pressure within 3 min of active standing 2.
• However, the specific condition of having low blood pressure when standing and high blood pressure when sitting or lying down is more closely related to a subtype of orthostatic hypotension, where patients experience supine hypertension, often coinciding with neurogenic orthostatic hypotension 3.

Characteristics and Symptoms

• Orthostatic hypotension can cause symptoms such as dizziness and palpitations 2.
• The condition can be debilitating and may increase the risk of adverse outcomes, including stroke, myocardial ischemia, and mortality 4.
• Clinical presentations of orthostatic hypotension can vary and range from cognitive slowing with hypotensive unawareness or unexplained falls to classic presyncope and syncope 3.

Diagnosis and Treatment

• Diagnosis of orthostatic hypotension requires careful history taking, a thorough physical examination, and supine and upright blood pressure measurements 3.
• Management of orthostatic hypotension may involve non-pharmacological interventions, such as increasing fluid and salt intake, and pharmacological agents like fludrocortisone and midodrine 5, 4.
• The treatment approach should be individualized, considering the underlying cause of orthostatic hypotension and the presence of supine hypertension 3, 4.