Rare case of orthostatic hypertension associated with postural loss of consciousness and cessation of respiration

Abstract

Orthostatic hypertension (OHT) is a rarely described clinical entity. OHT is characterized by a significant and rapid increase in blood pressure when a person assumes an upright posture. We present an interesting case of sudden and severe OHT in a young non-diabetic, paraplegic patient associated with transient loss of consciousness and cessation of respiration on assuming sitting position. However, this reverses quickly once supine position is assumed. In addition, this patient had chronic migraine and evidence of intracranial hypertension. It was difficult to manage his debilitating postural hemodynamic changes but he responded primarily to alpha-2 sympatholytic and later to alpha-1 sympatholytic drug satisfactorily. This combination of OHT with transient loss of consciousness and cessation of respiration make it, perhaps, a unique case in literature.