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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