January 14, 2019 0 By FM

The European and American medical associations have come to a consensus agreement on the definition and diagnosis of neurogenic supine hypertension, recently.

Until now, it was difficult to outline a generally accepted set of symptoms – and therefore to diagnose – for this type of high blood pressure.

With the publication of a consensus statement, experts from the European Federation of Autonomic Societies (EFAS) and the American Autonomic Society (AAS) have now reached an agreement on the subject.

Supine hypertension refers to high blood pressure that occurs when the sufferer is in a recumbent position. This is often caused by neurodegenerative conditions such as Parkinson’s, which attack the autonomic nervous system and in turn the mechanism controlling the cardiac muscle.

Supine hypertension can lead to strokes, brain haemorrhages and heart attacks. In view of these potentially fatal consequences, a clear definition of the symptoms and timely diagnosis of the condition is essential. But until recently, no international standard was in place.

“The consensus between the EU and US medical experts provides clear criteria for diagnosing supine hypertension. There were no clear-cut criteria before,” said EFAS President Prof. Walter Struhal.

The criteria apply to patients suffering from orthostatic hypotension – a form of low blood pressure that can lead to high pressure when the patient lies down, due to the condition’s impact on the autonomic nervous system. The consensus defines systolic blood pressure of more than 140mm Hg and/or diastolic blood pressure of more than 90mm Hg as an indication of supine hypertension, measured after at least five minutes of rest in a recumbent position. Criteria have also been defined which allow for distinctions to be made between mild, moderate and severe forms of the disease.

This consensus was urgently needed because large numbers of patients suffering from neurodegenerative conditions are also affected by circulatory dysregulation, said Prof Struhal.

Diagnosing such dysfunctions, which include supine hypertension, is simple, but there is little awareness of them. And of course, recognising the conditions is a prerequisite for effective treatment.

Autonomic nervous system disorders, some of which are extremely rare “orphan diseases”, pose particular challenges for neurologists, and represent a pioneering research topic.

According to Prof Struhal, a paper describing the recommendations on how to manage supine hypertension is in preparation.