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Supine hypertension: hemodynamic and neurohumoral mechanisms—reflections on the hypertension research update and perspectives 2025

Hypertension Research (2026)Cite this article

Supine hypertension, generally defined as systolic blood pressure (BP) of ≥140 mmHg and/or diastolic BP of ≥90 mmHg measured after at least 5 min of rest in the supine position [1], has been regarded as a clinical peculiarity seen mainly in patients with autonomic dysfunction. However, accumulating evidence suggests that it represents a distinct hemodynamic phenotype reflecting maladaptive interactions among the autonomic nervous system, renal sodium handling, and vascular stiffness [2]. In recent years, the ARIC study (Atherosclerosis Risk in Communities) has shown that supine hypertension is associated with increased risk of cardiovascular events, regardless of orthostatic hypotension status [3].

The Hypertension Research Update and Perspectives 2025 <Heart + Cardiovascular> session, held as part of the 47th Annual Scientific Meeting of the Japanese Society of Hypertension and presented by Dr. Takahiro Komori, provided a timely overview of the clinical significance of supine hypertension. The findings from Kario et al. [4] and Giao et al. [5] highlight that supine hypertension should not be considered a mere postural artifact but rather a manifestation of systemic dysregulation.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan

    Takeshi Fujiwara & Takahiro Komori

  2. Division of Cardiovascular-Renal-Metabolic Medicine, Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

    Masato Furuhashi

Authors
  1. Takeshi Fujiwara
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  2. Takahiro Komori
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  3. Masato Furuhashi
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Correspondence to Takeshi Fujiwara.

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Fujiwara, T., Komori, T. & Furuhashi, M. Supine hypertension: hemodynamic and neurohumoral mechanisms—reflections on the hypertension research update and perspectives 2025. Hypertens Res (2026). https://doi.org/10.1038/s41440-025-02533-0

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