This article is intended to provide guidance and clinical considerations for physicians
managing patients suffering from supine hypertension with orthostatic hypotension, referred to as
“SH-OH”. We review the normal physiologic response to orthostasis, focusing on the appropriate
changes to autonomic output in this state. Autonomic failure is discussed with a generalized overview
of the disease and examination of specific syndromes that help shed light on the pathophysiology
of SH-OH. The goal of this review is to provide a better framework for clinical evaluation of
these patients, review treatment options, and ultimately work toward achieving a better quality of
life for patients afflicted with this disease.