{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:26:28Z","timestamp":1787315188985,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Hypertension"],"published-print":{"date-parts":[[1997,11]]},"abstract":"<jats:p>\n                    <jats:italic>Abstract<\/jats:italic>\n                    We studied the incidence and severity of supine hypertension in 117 patients with severe primary autonomic failure presenting to a referral center over a 9-year period. Patients were uniformly characterized by disabling orthostatic hypotension, lack of compensatory heart rate increase, abnormal autonomic function tests, and unresponsive plasma norepinephrine. Fifty-four patients had isolated autonomic impairment (pure autonomic failure). Sixty-three patients had central nervous system involvement in addition to autonomic impairment (multiple-system atrophy). Patients were studied off medications, in a metabolic ward, and on a controlled diet containing 150 mEq of sodium. Fifty-six percent of patients had supine diastolic blood pressure \u226590 mm Hg. The prevalence of hypertension was slightly greater in females (63%) than in males (52%). Potential mechanisms responsible for this hypertension were investigated. No correlation was found between blood volume and blood pressure. Similarly, plasma norepinephrine (92\u00b115 pg\/mL) and plasma renin activity (0.3\u00b10.05 ng\/mL per hour) were very low in the subset of patients with pure autonomic failure and supine hypertension (mean systolic\/diastolic pressure, 177\u00b16\/108\u00b12 mm Hg, range 167\/97 to 219\/121). Supine hypertension represents a challenge in the treatment of orthostatic hypotension. We found these patients to be particularly responsive to the hypotensive effects of transdermal nitroglycerin. Doses ranging from 0.025 to 0.1 mg\/h decreased systolic blood pressure by 36\u00b17 mm Hg and may effectively treat supine hypertension overnight, but the dose should be individualized and used with caution.\n                  <\/jats:p>","DOI":"10.1161\/01.hyp.30.5.1062","type":"journal-article","created":{"date-parts":[[2012,6,11]],"date-time":"2012-06-11T20:53:46Z","timestamp":1339448026000},"page":"1062-1067","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":122,"title":["The Hypertension of Autonomic Failure and Its Treatment"],"prefix":"10.1161","volume":"30","author":[{"given":"John","family":"Shannon","sequence":"first","affiliation":[{"name":"From the Divisions of Clinical Pharmacology and Cardiology, the Clinical Research Center, and the Autonomic Dysfunction Center, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tenn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Jordan","sequence":"additional","affiliation":[{"name":"From the Divisions of Clinical Pharmacology and Cardiology, the Clinical Research Center, and the Autonomic Dysfunction Center, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tenn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Costa","sequence":"additional","affiliation":[{"name":"From the Divisions of Clinical Pharmacology and Cardiology, the Clinical Research Center, and the Autonomic Dysfunction Center, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tenn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose Marie","family":"Robertson","sequence":"additional","affiliation":[{"name":"From the Divisions of Clinical Pharmacology and Cardiology, the Clinical Research Center, and the Autonomic Dysfunction Center, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tenn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Italo","family":"Biaggioni","sequence":"additional","affiliation":[{"name":"From the Divisions of Clinical Pharmacology and Cardiology, the Clinical Research Center, and the Autonomic Dysfunction Center, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tenn."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","unstructured":"Robertson D Biaggioni I. Disorders of the Autonomic Nervous System. London UK: Harwood; 1995."},{"key":"e_1_3_2_2_2","first-page":"454","volume":"80","year":"1987","unstructured":"Onrot J, Goldberg MR, Hollister AS, Biaggioni I, Robertson RM, Robertson D. Management of chronic orthostatic hypotension. Am J Med. 1987;80:454-464.","journal-title":"Am J Med"},{"key":"e_1_3_2_3_2","first-page":"526","volume":"45","year":"1995","unstructured":"Robertson D, Davis TL. Recent advances in the treatment of orthostatic hypotension. Neurology. 1995;45:526-532.","journal-title":"Neurology"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.40.2.370"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410260410"},{"key":"e_1_3_2_6_2","first-page":"847","volume":"93","year":"1979","unstructured":"Workman RJ, Sussman CR, Burkit DW, Liddle GW. Circulating levels of angiotensin I measured by radioimmunoassay in hypertensive subjects. 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