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PD – Supine Hypertension Management — SCE Neurology MCQ

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HardMovement DisordersPD – Supine Hypertension ManagementSCE Neurology

A man taking midodrine at 08:00, 14:00 and 21:00 has improved standing symptoms but develops headache with a supine blood pressure of 188/104 mmHg at night. Which initial adjustment best targets the mechanism while preserving daytime benefit?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Omit late-evening dosing, ensure the final dose is at least four hours before bed, and elevate the head of the bed

Midodrine can cause clinically important supine hypertension. The final dose should be at least four hours before bedtime, and sleeping with the head elevated reduces nocturnal hypertension. If these and dose-reduction measures fail, treatment should be stopped. Moving a dose later, adding another pressor or dismissing the hypertension aggravates risk.

Reference: Midodrine Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/15180/smpc