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Supine hypertension and cardiovascular disease: controversies and advances

Sally K Zimmermann1, Kassem Farhat2, Samir Zaman1

  • 1Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Future Cardiology
|September 4, 2025
PubMed

Insights

Supine hypertension, often overlooked, poses a significant cardiovascular disease risk. This review synthesizes current literature, offering guidance on assessing and treating this potent risk factor.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • Elevated blood pressure is a primary risk factor for cardiovascular disease (CVD).
  • Current clinical guidelines for hypertension predominantly rely on seated measurements.
  • Emerging evidence indicates supine hypertension (SH) may be as significant as, or more so than, seated hypertension regarding cardiovascular risk and mortality.

Purpose of the Study:

  • To review and synthesize the existing literature on supine hypertension (SH).
  • To provide recommendations for the assessment, interpretation, and treatment of SH in outpatient settings.
  • To identify research gaps and future directions for understanding SH as a cardiovascular risk factor.

Main Methods:

  • A MEDLINE literature search was conducted for publications from 2024 to 2025.
  • The review synthesized findings related to supine hypertension assessment and treatment.
  • Recommendations were formulated based on the synthesized literature.

Main Results:

  • There is a lack of standardized protocols and diagnostic criteria for evaluating SH in the general population.
  • Clinical recommendations for managing detected SH are currently unclear.
  • The review highlights SH as an underappreciated yet potent risk factor for cardiovascular disease.

Conclusions:

  • Standardized protocols for SH assessment and clear treatment guidelines are needed.
  • Further research is crucial to fully understand the implications of SH for cardiovascular health.
  • Addressing SH could improve cardiovascular disease prevention strategies.

Keywords:
Supine hypertensionautonomic dysfunctioncardiovascular diseasenocturnal blood pressureorthostatic hypotensionsupine blood pressure

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