Clinostatic Hypertension and Orthostatic Hypotension

AbstractBackgroundThe association of clinostatic hypertension (CH) and orthostatic hypotension (OH) is described as the “Hyp‐Hyp phenomenon,” and it has been found in about 5.5% of hypertensive patients and in up to 50% of patients with OH. The importance of CH/OH in clinical practice is mainly due to the presence of troublesome symptoms, end‐organ damage, and difficulties in its clinical management.HypothesisThe review focuses on the clinical problem of CH and review the international literature for the best management, including the diagnostic work‐up and the taylored treatment for this kind of patients.MethodsA systematic review of the literature was conducted through MEDLINE research to focus the main controversial issues about CH/OH. Included topics: (1) the diagnostic work‐up, (2) the association with dysautonomic failure and syncope, and (3) the treatment options and prevention of end‐organ damage.ResultsCurrent standard reference for OH diagnosis includes functional assessment of the cardiac vagal nervous system and the sympathetic adrenergic system. The association with dysautonomic failure and with syncope needs further investigation. Pharmacologic treatment of OH is aime