Orthostatic Hypertension: When Pressor Reflexes Overcompensate

Joshua Fessel; David Robertson

Disclosures

Nat Clin Pract Nephrol. 2006;2(8):424-431. 

In This Article

Orthostatic Hypertension as a Feature of Other Conditions

Finally, orthostatic hypertension has been described as a clinical feature of a variety of other conditions, not all of which have blood pressure disturbances as a major symptom cluster. Patients exhibiting baroreflex failure are discussed above. Patients with pheochromocytoma, much like patients with baroreflex failure, may present with impressive labile hypertension that can be exacerbated by standing. Also like patients with baroreflex failure, however, this orthostatic hypertension may more properly be thought of as a manifestation of an underlying labile hypertension that in some patients will manifest as orthostatic hypertension. Interestingly, Yoshinari et al. have described orthostatic hypertension as a feature of type 2 diabetes mellitus.[31] Diabetic and non-diabetic subjects were classified as normotensive or hypertensive at the beginning of the study, and blood pressure was measured in the supine, sitting, and standing position. Orthostatic hypertension was defined as either an increase in DBP from <90 mmHg to ≥90 mmHg or an increase in SBP from <140 mmHg to ≥140 mmHg. In this sample, 12.8% of the normotensive diabetic patients had orthostatic hypertension, as compared to 1.8% of normotensive non-diabetic subjects. Hypertensive and normotensive diabetic subjects had a similar incidence of orthostatic hypertension. Interestingly, diabetic patients with orthostatic hypertension had decreased vibratory sense compared to diabetics without orthostatic hypertension and to non-diabetics. While this difference did not reach statistical significance, it may point to an important clinical correlation between orthostatic hypertension and neuropathy in this diabetic population. Jannetta and colleagues have emphasized a relationship between hypertension, including orthostatic hypertension, and medullary vascular compression.[32,33] These patients are believed to have compression from vascular loops which may interfere with medullary cardiovascular control centers. Jannetta has reported successful surgical treatment in some of these patients.

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