Treatment of supine hypertension in autonomic failure with gastrostomy feeding at night

Background Supine hypertension and post-prandial hypotension are associated with chronic autonomic failure, and may prove resistant to treatment. We determined if the hypotensive effects of food could be utilised to reduce supine hypertension in pure autonomic failure (PAF). Methods A subject with long-standing PAF, documented supine hypertension and post-prandial hypotension had a gastrostomy tube placed for dysphagia. We compared 24-hour ambulatory blood pressure recordings before and after nocturnal gastrostomy feeding. Results Gastrostomy feeding was associated with resolution of supine hypertension and normalization of circadian BP rhythm. Conclusions Gastrostomy feeding at night may help reduce supine hypertension in autonomic failure.