Purpose of Review

In autonomic failure, neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are interrelated conditions characterized by postural blood pressure (BP) dysregulation. nOH results in a sustained BP drop upon standing, which can lead to symptoms that include lightheadedness, orthostatic dizziness, presyncope, and syncope. nSH is characterized by elevated BP when supine and, although often asymptomatic, may increase long-term cardiovascular and cerebrovascular risk. This article reviews the pathophysiology and clinical characteristics of nOH and nSH, and describes the management of patients with both nOH and nSH.

Recent Findings

Pressor medications required to treat the symptoms of nOH also increase the risk of nSH. Because nOH and nSH are hemodynamically opposed, therapies to treat one condition may exacerbate the other. The management of patients with nOH who also have nSH can be challenging and requires an individualized approach to balance the short- and long-term risks associated with these conditions.

Summary

Approaches to manage neurogenic BP dysregulation include nonpharmacologic approaches and pharmacologic treatments. A stepwise treatment approach is presented to help guide neurologists in managing patients with both nOH and nSH.

中文翻译：

---

神经源性直立性低血压患者合并仰卧位高血压的治疗策略

 审查目的

在自主神经衰竭中，神经源性直立性低血压 (nOH) 和神经源性仰卧位高血压 (nSH) 是相互关联的病症，其特征是体位血压 (BP) 失调。 nOH 会导致站立时血压持续下降，从而导致头晕、直立性头晕、先兆晕厥和晕厥等症状。 nSH 的特点是仰卧时血压升高，尽管通常无症状，但可能会增加长期心脑血管风险。本文回顾了 nOH 和 nSH 的病理生理学和临床特征，并描述了 nOH 和 nSH 患者的治疗。

 最近的发现

治疗 nOH 症状所需的升压药物也会增加 nSH 的风险。由于 nOH 和 nSH 在血流动力学上是相反的，治疗一种病症的疗法可能会加剧另一种病症。对同时患有 nSH 的 nOH 患者进行管理可能具有挑战性，需要采取个体化方法来平衡与这些病症相关的短期和长期风险。

 概括

治疗神经源性血压失调的方法包括非药物方法和药物治疗。提出了一种逐步治疗方法，以帮助指导神经科医生治疗 nOH 和 nSH 患者。