The Hypertension-Hypotension Syndrome refers to the combination of supine hypertension and orthostatic hypotension.


(1) presence of arterial hypertension when supine

(2) presence of orthostatic hypotension

(2a) orthostatic systolic hypotension: drop of >= 20 mm Hg on standing

(2b) orthostatic diastolic hypotension: drop of >= 10 mm Hg on standing


Predisposing factors:

(1) elderly adult with chronic arterial hypertension

(2) autonomic failure

(3) bedridden

(4) drugs, including antihypertensive drugs

(5) hypovolemia, which may be caused by diuretic therapy

(6) impaired baroreflex

(7) cardiovascular disease (heart failure, venous insufficiency, capillary leak)


Symptoms associated with the orthostatic hypotension may include:

(1) visual disturbances

(2) impaired cognition

(3) fatigue

(4) nonspecific dizziness

(5) suboccipital pain


Evaluation using the head-up tilt test shows 4 reaction patterns:

(1) supine hypertension with neurogenic orthostatic hypotension

(2) supine hypertension with sustained hypotensive reaction

(3) supine hypertension with late onset vasovagal reaction

(4) supine hypertension with transient orthostatic hypotension early and cardioinhibitory reaction late

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