{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T04:02:19Z","timestamp":1780804939543,"version":"3.54.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Cardiac autonomic neuropathy is a highly prevalent pathology in the diabetic population, and is the leading cause of death in this population. Orthostatic hypotension is the main clinical manifestation of the disease. In some patients, this orthostatic hypotension is associated with supine hypertension, posing a therapeutic challenge since treatment of one entity may aggravate the other. The challenge is to manage each of these two hemodynamic opposites without exposing the patient to a life-threatening risk of severe hypotension or hypertension.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We report a case of a 62-year-old ethnic Moroccan woman who has cardiovascular risk factors such as type 2 diabetes, arterial hypertension, and dyslipidemia. The patient\u2019s symptoms included dizziness, tremors, morning sickness, palpitations, and intolerance to exertion. Given her symptomatology, the patient benefited from an exploration of the autonomic nervous system through cardiovascular reactivity tests (Ewing tests), which confirmed the diagnosis of cardiac autonomic neuropathy. In addition to orthostatic hypotension, our patient had supine arterial hypertension, complicating management. To treat orthostatic hypotension, we advised the patient to avoid the supine position during the day, to raise the head of the bed during the night, and to have a sufficient fluid intake, with a gradual transition from decubitus to orthostatism and venous restraint of the lower limbs. Supine hypertension was treated with transdermal nitrates placed at bedtime and removed 1\u00a0hour before getting up. One\u00a0week after the introduction of treatment, the patient reported a clear regression of functional symptoms, with an improvement in her quality of life. Improvement in symptomatology was maintained during quarterly follow-up consultations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Cardiac autonomic neuropathy is a very common pathology in diabetic patients. It is a serious condition with a life-threatening prognosis. Its management must be individualized according to the symptomatology and profile of each patient. The treatment of patients with orthostatic hypotension and supine hypertension requires special attention to ensure that each entity is treated without aggravating the other.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-024-04346-0","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T01:11:52Z","timestamp":1708391512000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A therapeutic challenge relating to the association of orthostatic hypotension and supine hypertension in a patient with cardiac autonomic neuropathy: a case report"],"prefix":"10.1186","volume":"18","author":[{"given":"Jama","family":"Dounia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haless","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selmaoui","family":"Marouane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haboub","family":"Meryem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habbal","family":"Rachida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drighil","family":"Abdenasser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azzouzi","family":"Leila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"4346_CR1","first-page":"1","volume":"23","author":"P Valensi","year":"1997","unstructured":"Valensi P, et\u00a0al. Autonomic neuropathy in diabetes. Diabetes Metab. 1997;23:1\u20138.","journal-title":"Diabetes Metab"},{"key":"4346_CR2","first-page":"2123","volume":"71","author":"AM Aring","year":"2005","unstructured":"Aring AM, Jones DE, Falko JM. Evaluation and prevention of diabetic neuropathy. Am Fam Physician. 2005;71:2123\u201330.","journal-title":"Am Fam Physician."},{"key":"4346_CR3","first-page":"498","volume":"60","author":"JC Philips","year":"2005","unstructured":"Philips JC, Marchand M, Scheen AJ. Diabetic cardiac autonomic neuropathy. Rev Med Li\u00e8ge. 2005;60:498\u2013504.","journal-title":"Rev Med Li\u00e8ge."},{"key":"4346_CR4","first-page":"1992","volume":"12","author":"TS Purewal","year":"1995","unstructured":"Purewal TS, Watkins PJ. Postural hypotension in diabetic autonomic neuropathy: a review. Diabetic Med. 1995;12:1992\u2013200.","journal-title":"Diabetic Med"},{"key":"4346_CR5","unstructured":"Boulton A, Valensi P, Tesfaye S. The diabetic neuropathies: reports from the Diabetic Neuropathy Expert Panel Meeting on Neuropathy, Toronto, October 2009. Introduction."},{"key":"4346_CR6","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.2337\/diacare.26.6.1895","volume":"26","author":"RE Maser","year":"2003","unstructured":"Maser RE, Mitchell BD, Vinik AI, et\u00a0al. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care. 2003;26:1895\u2013901.","journal-title":"Diabetes Care."},{"key":"4346_CR7","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.2337\/diacare.26.5.1553","volume":"26","author":"A Vinik","year":"2003","unstructured":"Vinik A, Maser R, Mitchell B, et\u00a0al. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553\u201379.","journal-title":"Diabetes Care."},{"key":"4346_CR8","doi-asserted-by":"publisher","first-page":"5896","DOI":"10.1210\/jc.2005-0754","volume":"90","author":"RE Maser","year":"2005","unstructured":"Maser RE, Lenhard MJ. Review: cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005;90:5896\u2013903.","journal-title":"J Clin Endocrinol Metab."},{"issue":"1","key":"4346_CR9","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/0002-9343(93)90230-M","volume":"95","author":"J Jankovic","year":"1993","unstructured":"Jankovic J, Gilden JL, Hiner BC, Kaufmann H, Brown DC, Coghlan CH, Rubin M, Fouad-Tarazi FM. Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine. Am J Med. 1993;95(1):38\u201348.","journal-title":"Am J Med"},{"issue":"2","key":"4346_CR10","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1111\/j.1524-6175.2001.00516.x","volume":"4","author":"J Jordan","year":"2002","unstructured":"Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens (Greenwich). 2002;4(2):139\u201345.","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"8","key":"4346_CR11","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1007\/s00415-016-8375-x","volume":"264","author":"CH Gibbons","year":"2017","unstructured":"Gibbons CH, Schmidt P, Biaggioni I, Frazier-Mills C, Freeman R, Isaacson S. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567\u201382.","journal-title":"J Neurol."},{"issue":"1","key":"4346_CR12","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1212\/WNL.51.1.120","volume":"51","author":"RA Wright","year":"1998","unstructured":"Wright RA, Kaufmann HC, Perera R, Opfer-Gehrking TL, McElligott MA, Sheng KN, Low PA. A double-blind dose-response study of midodrine in neurogenic orthostatic hypotension. Neurology. 1998;51(1):120\u20134.","journal-title":"Neurology"},{"issue":"11","key":"4346_CR13","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.1007\/s11606-013-2520-3","volume":"28","author":"AK Parsaik","year":"2013","unstructured":"Parsaik AK, Singh B, Altayar O, Mascarenhas SS, Singh SK, Erwin PJ, Murad MH. Midodrine for orthostatic hypotension: a systematic review and meta-analysis of clinical trials. J Gen Intern Med. 2013;28(11):1496\u2013503.","journal-title":"J Gen Intern Med"},{"key":"4346_CR14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.19102\/icrm.2016.070003","volume":"7","author":"A Ahmad","year":"2016","unstructured":"Ahmad A, Grubb B, Zaman L, Kanjwal K. Syndrome of supine hypertension with orthostatic hypotension: a nightmare for physicians. J Innov Cardiac Rhythm Manag. 2016;7:1\u20134.","journal-title":"J Innov Cardiac Rhythm Manag"},{"issue":"3","key":"4346_CR15","doi-asserted-by":"publisher","first-page":"91","DOI":"10.19144\/1911-1606.9.3.2","volume":"9","author":"M Lamarre-Clich\u00e9","year":"2014","unstructured":"Lamarre-Clich\u00e9 M. Orthostatic hypotension and supine hypertension in the patient with autonomic failure. Can J Gen Intern Med. 2014;9(3):91\u20135.","journal-title":"Can J Gen Intern Med."}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04346-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-024-04346-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04346-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T01:12:30Z","timestamp":1708391550000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-024-04346-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4346"],"URL":"https:\/\/doi.org\/10.1186\/s13256-024-04346-0","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"assertion":[{"value":"24 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 December 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This case report was conducted in accordance with the declaration of Helsinki. The collection and evaluation of all protected patient health information was performed in a health insurance portability and accountability Act. we know of no conflicts of interest associated with this publication.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"102"}}