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Clinical Autonomic Research
Published in: Clinical Autonomic Research 4/2018

Open Access 01-08-2018 | Consensus Statement

Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)

Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH)

Authors: Alessandra Fanciulli, Jens Jordan, Italo Biaggioni, Giovanna Calandra–Buonaura, William P. Cheshire, Pietro Cortelli, Sabine Eschlboeck, Guido Grassi, Max J. Hilz, Horacio Kaufmann, Heinz Lahrmann, Giuseppe Mancia, Gert Mayer, Lucy Norcliffe–Kaufmann, Anne Pavy–Le Traon, Satish R. Raj, David Robertson, Isabel Rocha, Walter Struhal, Roland Thijs, Konstantinos P. Tsioufis, J. Gert van Dijk, Gregor K. Wenning

Published in: Clinical Autonomic Research | Issue 4/2018

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Abstract

Purpose

Patients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which falls in the upright position owing to impaired autonomic regulation. A committee was formed to reach consensus among experts on the definition and diagnosis of nSH in the context of cardiovascular autonomic failure.

Methods

As a first and preparatory step, a systematic search of PubMed-indexed literature on nSH up to January 2017 was performed. Available evidence derived from this search was discussed in a consensus expert round table meeting in Innsbruck on February 16, 2017. Statements originating from this meeting were further discussed by representatives of the American Autonomic Society and the European Federation of Autonomic Societies and are summarized in the document presented here. The final version received the endorsement of the European Academy of Neurology and the European Society of Hypertension.

Results

In patients with neurogenic orthostatic hypotension, nSH is defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, measured after at least 5 min of rest in the supine position. Three severity degrees are recommended: mild, moderate and severe. nSH may also be present during nocturnal sleep, with reduced-dipping, non-dipping or rising nocturnal BP profiles with respect to mean daytime BP values. Home BP monitoring and 24-h-ambulatory BP monitoring provide relevant information for a customized clinical management.

Conclusions

The establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.
Literature
1.
Benarroch EE (2014) The clinical approach to autonomic failure in neurological disorders. Nat Rev Neurol 10(7):396–407CrossRefPubMed
2.
Freeman R, Wieling W, Axelrod FB et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21(2):69–72CrossRefPubMed
3.
Fanciulli A, Gobel G, Ndayisaba JP et al (2016) Supine hypertension in Parkinson’s disease and multiple system atrophy. Clin Auton Res 26(2):97–105CrossRefPubMed
4.
Cicolini G, Pizzi C, Palma E et al (2011) Differences in blood pressure by body position (supine, Fowler’s, and sitting) in hypertensive subjects. Am J Hypertens 24(10):1073–1079CrossRefPubMed
5.
Krzesinski P, Stanczyk A, Gielerak G, Piotrowicz K, Banak M, Wojcik A (2016) The diagnostic value of supine blood pressure in hypertension. Arch Med Sci 12(2):310–318CrossRefPubMedPubMedCentral
6.
Goldstein DS, Pechnik S, Holmes C, Eldadah B, Sharabi Y (2003) Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension 42(2):136–142CrossRefPubMed
7.
Parati G, Stergiou G, O’Brien E et al (2014) European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 32(7):1359–1366CrossRefPubMed
8.
Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219CrossRefPubMed
9.
10.
Jordan J, Shannon JR, Pohar B et al (1999) Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure. J Am Soc Nephrol 10(1):35–42PubMed
11.
Pinna G, Pascale C, Fornengo P et al (2014) Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS One 9(4):e93542CrossRefPubMedPubMedCentral
12.
Sandroni P, Benarroch EE, Wijdicks EF (2001) Caudate hemorrhage as a possible complication of midodrine-induced supine hypertension. Mayo Clin Proc 76(12):1275CrossRefPubMed
13.
Chaimberg KH, Travis KW (2002) Supine hypertension during general anesthesia in a patient taking midodrine. Anesth Analg 95(5):1196–1197 (table of contents)CrossRefPubMed
14.
Cilia R, Cereda E, Klersy C et al (2015) Parkinson’s disease beyond 20 years. J Neurol Neurosurg Psychiatry 86(8):849–855CrossRefPubMed
15.
Stubendorff K, Aarsland D, Minthon L, Londos E (2012) The impact of autonomic dysfunction on survival in patients with dementia with lewy bodies and Parkinson’s disease with dementia. PLoS One 7(10):e45451CrossRefPubMedPubMedCentral
16.
CCalandra-Buonaura G, Guaraldi P, Sambati L, et al (2013) Multiple system atrophy with prolonged survival: is late onset of dysautonomia the clue? Neurol Sci 34(10):1875–1878CrossRef
17.
Petrovic IN, Ling H, Asi Y et al (2012) Multiple system atrophy-parkinsonism with slow progression and prolonged survival: a diagnostic catch. Mov Disord 27(9):1186–1190CrossRefPubMed
18.
O’Sullivan SS, Massey LA, Williams DR et al (2008) Clinical outcomes of progressive supranuclear palsy and multiple system atrophy. Brain 131(Pt 5):1362–1372CrossRefPubMed
19.
Tada M, Onodera O, Ozawa T et al (2007) Early development of autonomic dysfunction may predict poor prognosis in patients with multiple system atrophy. Arch Neurol 64(2):256–260CrossRefPubMed
20.
Watanabe H, Saito Y, Terao S et al (2002) Progression and prognosis in multiple system atrophy: an analysis of 230 Japanese patients. Brain 125(Pt 5):1070–1083CrossRefPubMed
21.
Maule S, Milan A, Grosso T, Veglio F (2006) Left ventricular hypertrophy in patients with autonomic failure. Am J Hypertens 19(10):1049–1054CrossRefPubMed
22.
Maule S, Milazzo V, Maule MM, Di Stefano C, Milan A, Veglio F (2012) Mortality and prognosis in patients with neurogenic orthostatic hypotension. Funct Neurol 27(2):101–106PubMedPubMedCentral
23.
Vagaonescu TD, Saadia D, Tuhrim S, Phillips RA, Kaufmann H (2000) Hypertensive cardiovascular damage in patients with primary autonomic failure. Lancet 355(9205):725–726CrossRefPubMed
24.
25.
Oh YS, Kim JS, Lee KS (2013) Orthostatic and supine blood pressures are associated with white matter hyperintensities in Parkinson disease. J Mov Disord 6(2):23–27CrossRefPubMedPubMedCentral
26.
Pilleri M, Facchini S, Gasparoli E et al (2013) Cognitive and MRI correlates of orthostatic hypotension in Parkinson’s disease. J Neurol 260(1):253–259CrossRefPubMed
27.
Kim JS, Oh YS, Lee KS, Kim YI, Yang DW, Goldstein DS (2012) Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease. Neurology 79(13):1323–1331CrossRefPubMedPubMedCentral
28.
Gorell JM, Johnson CC, Rybicki BA (1994) Parkinson’s disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to 1990. Neurology 44(10):1865–1868CrossRefPubMed
29.
Tha KK, Terae S, Yabe I et al (2010) Microstructural white matter abnormalities of multiple system atrophy: in vivo topographic illustration by using diffusion-tensor MR imaging. Radiology 255(2):563–569CrossRefPubMed
30.
Lim TS, Lee PH, Kim HS, Yong SW (2009) White matter hyperintensities in patients with multiple system atrophy. J Neurol 256(10):1663–1670CrossRefPubMed
31.
Jones JD, Jacobson C, Murphy M, Price C, Okun MS, Bowers D (2014) Influence of hypertension on neurocognitive domains in nondemented Parkinson’s disease patients. Parkinsons Dis 2014:507529PubMedPubMedCentral
32.
Hohler AD, Zuzuarregui JR, Katz DI et al (2012) Differences in motor and cognitive function in patients with Parkinson’s disease with and without orthostatic hypotension. Int J Neurosci 122(5):233–236CrossRefPubMed
33.
Allcock LM, Kenny RA, Mosimann UP et al (2006) Orthostatic hypotension in Parkinson’s disease: association with cognitive decline? Int J Geriatr Psychiatry 21(8):778–783CrossRefPubMed
34.
Peralta C, Stampfer-Kountchev M, Karner E et al (2007) Orthostatic hypotension and attention in Parkinson’s disease with and without dementia. J Neural Transm 114(5):585–588CrossRefPubMed
35.
Brown RG, Lacomblez L, Landwehrmeyer BG et al (2010) Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy. Brain 133(Pt 8):2382–2393CrossRefPubMed
36.
Deguchi K, Takeuchi H, Sasaki I, Tsukaguchi M, Touge T, Nishioka M (2001) Impaired novelty P3 potentials in multiple system atrophy—correlation with orthostatic hypotension. J Neurol Sci 190(1–2):61–67CrossRefPubMed
37.
Milazzo V, Di Stefano C, Milan A et al (2015) Cardiovascular complications in patients with autonomic failure. Clin Auton Res 25(3):133–140CrossRefPubMed
38.
Rothwell PM (2010) Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 375(9718):938–948CrossRefPubMed
39.
Umehara T, Matsuno H, Toyoda C, Oka H (2016) Clinical characteristics of supine hypertension in de novo Parkinson disease. Clin Auton Res 26(1):15–21CrossRefPubMed
40.
Shannon J, Jordan J, Costa F, Robertson RM, Biaggioni I (1997) The hypertension of autonomic failure and its treatment. Hypertension 30(5):1062–1067CrossRefPubMed
41.
Biaggioni I, Robertson RM (2002) Hypertension in orthostatic hypotension and autonomic dysfunction. Cardiol Clin 20(2):291–301 (vii)CrossRefPubMed
42.
Pavy-Le Traon A, Piedvache A, Perez-Lloret S et al (2016) New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study. J Neurol Neurosurg Psychiatry 87(5):554–561CrossRefPubMed
43.
Berganzo K, Diez-Arrola B, Tijero B et al (2013) Nocturnal hypertension and dysautonomia in patients with Parkinson’s disease: are they related? J Neurol 260(7):1752–1756CrossRefPubMed
44.
Fanciulli A, Strano S, Ndayisaba JP et al (2014) Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm. J Neurol 261(7):1291–1299CrossRefPubMed
45.
Plaschke M, Trenkwalder P, Dahlheim H, Lechner C, Trenkwalder C (1998) Twenty-four-hour blood pressure profile and blood pressure responses to head-up tilt tests in Parkinson’s disease and multiple system atrophy. J Hypertens 16(10):1433–1441CrossRefPubMed
46.
Schmidt C, Berg D, Prieur S et al (2009) Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov Disord 24(14):2136–2142CrossRefPubMed
47.
Celedonio JE, Arnold AC, Dupont WD et al (2015) Residual sympathetic tone is associated with reduced insulin sensitivity in patients with autonomic failure. Clin Auton Res 25(5):309–315CrossRefPubMedPubMedCentral
48.
Struhal W, Lahrmann H, Mathias CJ (2013) Incidence of cerebrovascular lesions in pure autonomic failure. Auton Neurosci 179(1–2):159–162CrossRefPubMed
49.
Madacsy L, Yasar A, Tulassay T et al (1995) Association of relative nocturnal hypertension and autonomic neuropathy in insulin-dependent diabetic children. Acta Biomed Ateneo Parmense 66(3–4):111–118PubMed
50.
Chang J, Hou YP, Wu JL et al (2017) Blood pressure circadian rhythms and adverse outcomes in type 2 diabetics diagnosed with orthostatic hypotension. J Diabetes Investig 9(2):383–388CrossRefPubMedPubMedCentral
51.
Arnold AC, Okamoto LE, Gamboa A et al (2016) Mineralocorticoid receptor activation contributes to the supine hypertension of autonomic failure. Hypertension 67(2):424–429PubMedCrossRef
52.
Arnold AC, Okamoto LE, Gamboa A et al (2013) Angiotensin II, independent of plasma renin activity, contributes to the hypertension of autonomic failure. Hypertension 61(3):701–706CrossRefPubMed
53.
Shannon JR, Jordan J, Diedrich A et al (2000) Sympathetically mediated hypertension in autonomic failure. Circulation 101(23):2710–2715CrossRefPubMed
54.
55.
Gamboa A, Shibao C, Diedrich A et al (2008) Excessive nitric oxide function and blood pressure regulation in patients with autonomic failure. Hypertension 51(6):1531–1536CrossRefPubMedPubMedCentral
56.
Pavelic A, Krbot Skoric M, Crnosija L, Habek M (2017) Postprandial hypotension in neurological disorders: systematic review and meta-analysis. Clin Auton Res 27(4):263–271CrossRefPubMed
57.
Norcliffe–Kaufmann L, Kaufmann H (2014) Is ambulatory blood pressure monitoring useful in patients with chronic autonomic failure? Clin Auton Res 24(4):189–192CrossRefPubMed
58.
van Lieshout JJ, ten Harkel AD, Wieling W (2000) Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure. Clin Auton Res 10(1):35–42CrossRefPubMed
59.
Gama RL, Tavora DG, Bomfim RC, Silva CE, de Bruin VM, de Bruin PF (2010) Sleep disturbances and brain MRI morphometry in Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy—a comparative study. Parkinsonism Relat Disord 16(4):275–279CrossRefPubMed
60.
Ghorayeb I, Yekhlef F, Chrysostome V, Balestre E, Bioulac B, Tison F (2002) Sleep disorders and their determinants in multiple system atrophy. J Neurol Neurosurg Psychiatry 72(6):798–800CrossRefPubMedPubMedCentral
61.
Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P (2016) Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 26:43–56CrossRefPubMed
62.
Cuspidi C, Meani S, Valerio C et al (2007) Reproducibility of dipping/nondipping pattern in untreated essential hypertensive patients: impact of sex and age. Blood Press Monit 12(2):101–106CrossRefPubMed
63.
Stenehjem AE, Os I (2004) Reproducibility of blood pressure variability, white-coat effect and dipping pattern in untreated, uncomplicated and newly diagnosed essential hypertension. Blood Press 13(4):214–224CrossRefPubMed
Metadata
Title
Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)
Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH)
Authors
Alessandra Fanciulli
Jens Jordan
Italo Biaggioni
Giovanna Calandra–Buonaura
William P. Cheshire
Pietro Cortelli
Sabine Eschlboeck
Guido Grassi
Max J. Hilz
Horacio Kaufmann
Heinz Lahrmann
Giuseppe Mancia
Gert Mayer
Lucy Norcliffe–Kaufmann
Anne Pavy–Le Traon
Satish R. Raj
David Robertson
Isabel Rocha
Walter Struhal
Roland Thijs
Konstantinos P. Tsioufis
J. Gert van Dijk
Gregor K. Wenning
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
Clinical Autonomic Research / Issue 4/2018
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-018-0529-8

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