Figure 4. Effect of different antihypertensive medications and nonpharmacological interventions on nocturnal hypertension, diuresis, and morning orthostatic tolerance in patients with supine hypertension and OH.

Interventions were tested on a series of single-night, placebo-controlled crossover, proof-of-concept studies.^131,132 Outcomes were monitored from 8 pm to 8 am, followed by a 10-minute standing test in the morning. A single oral dose of each medication was given at 8 pm; nitroglycerin (NTG) patch was applied from 8 pm to 6 am; and local heat and continuous positive airway pressure (CPAP) were applied from 10 pm to 6 am. Vertical bar represents the maximum observed systolic blood pressure (SBP) reduction over night. Asterisk represents interventions that significantly reduced nighttime SBP. Only local heat and CPAP treatment reduce nocturnal diuresis and improve morning orthostatic tolerance. Red indicates the observed effect. Nifedipine here is the immediate-release formulation. OH indicates orthostatic hypotension; RAAS, renin-angiotensin-aldosterone system; and SNS, sympathetic nervous system. Figure courtesy of Luis E. Okamoto, Vanderbilt University Medical Center. Adapted with permission from Park et al.¹³³