Orthostatic Hypertension: When Pressor Reflexes Overcompensate

Joshua Fessel; David Robertson


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

In This Article


Orthostatic hypertension is a real clinical phenomenon that is associated with a variety of underlying conditions (Box 2). It has been associated with important clinical correlates such as silent CNS ischemia/infarct, overt stroke, and neuropathy in the context of type 2 diabetes. The underlying pathophysiology is poorly understood at present but seems to involve activation of the sympathetic nervous system. A better understanding of the underlying pathophysiology is very important, as it could have direct implications for possible therapies. Diagnostic criteria are ill-defined at present, and a consensus should be reached regarding the clinical diagnosis of orthostatic hypertension. There are essentially no data regarding what the further diagnostic or therapeutic implications are for a diagnosis of orthostatic hypertension. Should the condition be treated as an independent therapeutic target in the context of hypertension? What are the optimal treatment strategies? What are the benefits and risks of treating orthostatic hypertension? These and many other questions have yet to be addressed. Clearly orthostatic hypertension represents an aspect of hypertension that is poorly understood and is in need of focused basic science and clinical inquiry.

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