Head-up tilt sleeping in Parkinson disease and multiple system atrophy : Towards a better understanding and treatment of cardiovascular autonomic failure

A common non-motor symptom of Parkinson's disease (PD) and multiple system atrophy (MSA) is autonomic failure, causing blood pressure problems such as orthostatic hypotension (OH) and supine hypertension. A retrospective analysis revealed that the main haemodynamic factor behind this co-occurrence is a high total peripheral resistance during supine rest, which fails to increase under orthostatic stress. Treating both blood pressure issues simultaneously is challenging, and a promising non-pharmacological approach is full-body head-up tilt sleeping (HUTS). HUTS may improve OH and reduce nocturnal hypertension, but its effectiveness and optimal angle remain unclear. 
The Heads-Up study evaluated the efficacy and tolerability of HUTS in people with PD and MSA with both OH and supine hypertension. Participants slept at three progressively steeper angles for two weeks each. While average nighttime blood pressure did not significantly change, HUTS improved overall blood pressure regulation: early-morning supine BP decreased, nocturnal dipping improved, and OH and orthostatic tolerance improved. Higher angles were more effective but less tolerable, highlighting the need for professional guidance. HUTS appears feasible and beneficial for blood pressure regulation, offering a unique treatment option for cardiovascular autonomic failure in PD and MSA.