Syndrome of Orthostatic Hypotension with Supine Hypertension: A Therapeutic Dilemma for Cardiologists

Orthostatic hypotension (OH) and supine hypertension (SH) are two cardiovascular symptoms of autonomic failure that frequently coexist in the same patient. Clinicians are faced with a dilemma because aggressive orthostatic intolerance treatment can exacerbate supine hypertension, and vice versa for supine hypertension management. The objective of our article is to provide a better framework for the clinical evaluation, the right choice of therapeutic options and the improvement of the quality of life of patients with OH-SH syndrome. For these reasons, we report three observations, whose etiologies, clinical presentation, and treatment are different, namely diabetes, multiple system atrophy type C (MSA) and Parkinson's disease.