Elevated blood pressure is one of the most important risk factors for cardiovascular disease (CVD). Despite blood pressure being historically measured in the supine position prior to the 20th century, current clinical guidelines are primarily based on seated measurements. Emerging evidence suggests that hypertension in the supine position may be equally or more strongly associated with cardiovascular risk and mortality than seated hypertension. However, there is no standardized protocol or diagnostic criteria to evaluate supine hypertension (SH) in the general population. Moreover, if SH is detected, clinical recommendations for its treatment remain unclear. In this review, we synthesized the literature on SH by conducting a MEDLINE search of publications from 2024 to 2025 and offer recommendations for the assessment, interpretation, and treatment of SH in the outpatient setting. In addition, we identify gaps in evidence and opportunities for future research to advance our understanding of this underappreciated and yet potent risk factor for cardiovascular disease.
Keywords: Supine hypertension; autonomic dysfunction; cardiovascular disease; nocturnal blood pressure; orthostatic hypotension; supine blood pressure.
High blood pressure is a common condition that increases the risk of stroke and heart attack. Supine hypertension(SH), which is high blood pressure when lying down, is strongly related to risk of future heart disease, even when patients have a normal blood pressure while seated. However, supine blood pressure is not commonly measured in clinics. Screening for SH may identify patients who would benefit from treatment to improve blood pressure control regardless of body position. Currently, there is limited guidance on how to diagnose and treat this underrecognized condition. This article provides an overview of the potential mechanisms of SH, and the latest thinking about how it can be detected, diagnosed, and treated.