orthostatic hypotension, lying supine and kidney

Q: 68-year-old male with a history of severe diabetes, autonomic dysfunction, moderate renal insufficiency, and known orthostatic hypotension is recovering in ICU from a bout of Diabetes Ketoacidosis (DKA).  Patient's blood pressure while lying supine tends to be? (select one)

A) high

B) low

Answer: A

Supine hypertension is a known side effect of patients with orthostatic hypotension. Supine hypertension is a systolic blood pressure (SBP) of at least 140 mmHg or a diastolic blood pressure of at least 90 mmHg after at least five minutes in the supine resting position. 

A large number of patients with a history of orthostatic hypotension tend to have supine hypertension along with renal dysfunction. These patients should be advised to sleep while raising the head of the bed 30 to 45 degrees. This simple maneuver decreases nocturnal diuresis, reducing supine hypertension and end-organ damage.

#hemodynamics

#nephrology

#cardiology

#endocrinology

#neurology

References:

1. Fanciulli A, Jordan J, Biaggioni I, et al. Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS) : Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH). Clin Auton Res 2018; 28:355.

2. Fan CW, Walsh C, Cunningham CJ. The effect of sleeping with the head of the bed elevated six inches on elderly patients with orthostatic hypotension: an open randomised controlled trial. Age Ageing 2011; 40:187.