Orthostatic Hypertension: When Pressor Reflexes Overcompensate

Authors and Disclosures

J. Fessel is an intern in the Department of Medicine at Vanderbilt University, and D. Robertson is the Elton Yates Professor of Medicine, Pharmacology and Neurology, and Director of the General Clinical Research Center at Vanderbilt University, Nashville, TN, USA.

Competing interests: The authors declared no competing interests.

Sidebar: Box 1. Definitions of Orthostatic Hypotension and Orthostatic Hypertension.

Orthostatic hypotension

• Systolic blood pressure decreases by at least 20 mmHg upon standing
  
  

• Diastolic blood pressure decreases by at least 10 mmHg upon standing

Orthostatic hypertension

• Systolic blood pressure increases by at least 20 mmHg upon standing
  
  

• No change in diastolic blood pressure has been defined

Sidebar: Box 2. Conditions in Which Orthostatic Hypertension is a Notable Feature.

Chronic primary conditions

• Essential hypertension in the elderly
  
  

• Essential hypertension with abnormal diurnal variation ('extreme dippers')
  
  

• Type 2 diabetes mellitus

Dysautonomias

• Postural tachycardia syndrome with disorder of mast-cell activation
  
  

• Norepinephrine transporter deficiency

• Baroreflex failure (acute)

Potentially surgically-correctable conditions

• Pheochromocytoma

• Medullary vascular compression

Sidebar: Key Points

• Orthostatic hypertension—in contrast to orthostatic hypotension—is an understudied and often overlooked form of blood pressure dysregulation
  
  

• There is no generally accepted definition of orthostatic hypertension; an increase in systolic blood pressure of 20 mmHg or more upon standing has been proposed
  
  

• Physiological processes that might underlie orthostatic hypertension include excessive venous pooling leading to decreased cardiac output, activation of the sympathetic nervous system, and increased levels of circulating hormones
  
  

• Orthostatic hypertension is a feature of several conditions and patient subgroups, including essential hypertension in the elderly and 'extreme dippers', dysautonomias, and pheochromocytoma
  
  

• In the absence of data on specific therapies, management of orthostatic hypertension should be a function mainly of the condition of which it is a feature, and might include adrenergic receptor antagonists