From the Research
Orthostatic hypertension is the type of dysautonomia where blood pressure rises when changing from a supine to standing position, rather than falling as seen in orthostatic hypotension. This condition is characterized by an abnormal increase in systolic blood pressure of at least 20 mmHg upon standing. It can occur in several forms, including baroreflex failure, essential hypertension with sympathetic overactivity, and pheochromocytoma-related dysautonomia. Management typically involves medications that block the sympathetic nervous system's effects, such as alpha-blockers (like doxazosin starting at 1mg daily, gradually increasing to 4-8mg daily as needed) or combined alpha/beta-blockers (like labetalol at 100mg twice daily, adjustable up to 400mg twice daily) 1, 2. Lifestyle modifications are also important, including gradual position changes, adequate hydration, and salt moderation. The underlying mechanism involves dysfunction in the autonomic nervous system's regulation of blood pressure, specifically an exaggerated sympathetic response or impaired baroreceptor function that fails to properly modulate blood pressure during positional changes. Some studies have investigated the use of fludrocortisone and midodrine in the treatment of orthostatic hypotension, but their effectiveness in orthostatic hypertension is less clear 3, 4, 5. Patients should monitor their blood pressure regularly and report significant symptoms like severe headaches, visual disturbances, or dizziness that occur upon standing. Key points to consider in the management of orthostatic hypertension include:
- Monitoring blood pressure regularly
- Reporting significant symptoms
- Gradual position changes
- Adequate hydration
- Salt moderation
- Medications such as alpha-blockers or combined alpha/beta-blockers. It is essential to prioritize the patient's quality of life, morbidity, and mortality when managing orthostatic hypertension, and to individualize treatment based on the underlying cause and severity of the condition.