Which medications are used in the treatment of supine hypertension in patients with multiple system atrophy (MSA)?

Updated: Oct 17, 2018
  • Author: André Diedrich, MD, PhD; Chief Editor: Selim R Benbadis, MD  more...
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The presence of supine hypertension can complicate the pharmacologic management of patients with MSA, but a rational approach to its treatment is often successful. Simply avoiding the supine position is often enough to control hypertension during the day. Treatment of supine hypertension is required at night. Elevating the head of the bed is useful but rarely sufficient. Short-acting vasodilators are effective in controlling hypertension.

The management of patients with orthostatic hypotension and supine hypertension can be challenging, but adequate BP control is often achieved by combining the nonpharmacologic approach, as previously described, with the following medications:

  • Nitrates, transdermal nitroglycerin (0.1–0.2 mg/h)

  • Hydralazine (50 mg)

  • Nifedipine; short-acting calcium blocker (10-30 mg)

  • Clonidine (0.1 mg), early in the evening [43]

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