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Orthostatic hypotension (OH) and supine hypertension (SH) are hallmark manifestations of cardiovascular autonomic dysfunction that are increasingly recognized as contributors to long\u2010term adverse clinical outcomes such as accelerated cognitive decline, motor symptom exacerbation, and end\u2010organ damage. Several atypical presentations of OH, including coat\u2010hanger pain, cognitive fluctuation, postural instability, fatigue, exertional dyspnea, and falls, commonly overlap with motor and non\u2010motor features of synucleinopathies. This clinical overlap highlights the need for heightened awareness of the diverse and often subtle manifestations of OH in affected individuals. Although the general management of OH has been addressed in prior literature, a dedicated framework tailored to the pathophysiological and clinical nuances specific to synucleinopathies remains lacking. SH, despite its high prevalence and significant prognostic implications, has received minimal attention in existing reviews and is often overlooked in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Given the growing recognition of cardiovascular autonomic dysfunction as a potentially modifiable contributor to disease progression and patient quality of life, a focused updated review is warranted to inform clinical decision\u2010making and guide future research in this evolving area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This narrative review comprehensively discusses the approach to OH and SH in the context of synucleinopathies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The key topics addressed are the pathophysiology of OH and SH in synucleinopathies, diagnostic criteria and types of OH, diagnostic criteria of SH, and management strategies (non\u2010pharmacological, pharmacological, and novel\/experimental).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70268","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T06:43:58Z","timestamp":1754635438000},"page":"2092-2105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Approach to Cardiovascular Autonomic Dysfunction in Patients with Synucleinopathies"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0725-636X","authenticated-orcid":false,"given":"Abhishek","family":"Lenka","sequence":"first","affiliation":[{"name":"Department of Neurology University of Texas Southwestern Medical 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