Management of Supine Hypertension

 • Avoid offending agents

 • Avoid lying down during the day; rest in the seated position

 • Beware 'Hidden' pressor agents: Ibuprofen, Indomethacin, Atomoxetine

 • Limit water ingestion near bedtime

 • Avoid fludrocortisone in favor of short-acting pressor agents when possible

 • Nonpharmacological treatments

    - Tilt the whole bed head-up by approximately 10°, in patients not tolerating this measure tilt only the head of the bed up 30°

    - Carbohydrate-rich snack at bedtime

    - If alcohol consumed, small amount at bedtime

 • Pharmacological treatments - Consider individualized antihypertensive treatment taken at bedtime

 • Monitor night-time blood pressure with 24 h ambulatory blood pressure monitors

    - Before starting treatment to see if patient 'dips' to a normal pressure later in the night

    - To monitor treatment efficacy



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