How This Easy Change to BP Reading Can Reveal Hidden Risks

TOPLINE:

Having supine hypertension, regardless of seated or treated hypertension, is associated with an increased risk for adverse cardiovascular outcomes. Having supine hypertension was consistently associated with a greater risk for all cardiovascular outcomes than seated hypertension.

METHODOLOGY:

• Researchers conducted a prospective analysis using data from the ARIC study to examine the association between supine hypertension and the risk for cardiovascular disease events in 11,369 participants (mean age, 53.9 years; 55.7% women; 74.9% White individuals) without known cardiovascular disease.
• They compared the outcomes between participants with hypertension in both supine and seated positions, the supine position alone, or the seated position alone, and those without hypertension in either position.
• Supine hypertension was defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg in the supine position, and seated hypertension was defined as the same thresholds in the seated position.
• The primary outcomes were incident coronary heart disease, heart failure, and stroke; fatal heart disease; and all-cause mortality.
• The median follow-up duration was 25.7 years for incident coronary heart disease, 28.3 years for fatal heart disease, 26.9 years for incident heart failure, 27.6 years for incident stroke, and 28.3 years for all-cause mortality.

TAKEAWAY:

• Having supine hypertension was associated with higher risks for incident coronary heart disease (adjusted hazard ratio [aHR], 1.60; 95% CI, 1.45-1.76), fatal heart disease (aHR, 2.18; 95% CI, 1.84-2.59), incident heart failure (aHR, 1.83; 95% CI, 1.68-2.01), incident stroke (aHR, 1.86; 95% CI, 1.63-2.13), and all-cause mortality (aHR, 1.43; 95% CI, 1.35-1.52) than not having the condition.
• The association between having supine hypertension and the risk for adverse cardiovascular disease events persisted, regardless of having seated hypertension or the usage of antihypertensive medications.
• Compared with not having hypertension in both positions, having hypertension in the seated position alone was associated with a higher risk for fatal coronary heart disease and all-cause mortality, whereas that in the supine position alone was associated with a higher risk for all primary cardiovascular disease events.
• Having seated hypertension alone was associated with lower risks for all outcomes except fatal heart disease than having supine hypertension alone.

IN PRACTICE:

“While hypertension in both seated and supine positions was associated with the highest risk of adverse events, having supine hypertension without seated hypertension and independent of seated BP [blood pressure] was also a potent risk factor associated with CVD [cardiovascular disease]. For most outcomes, the risk was quite similar to that associated with having hypertension in both positions,” the authors wrote.

“Given the simplicity of performing a supine BP in the clinic and the opportunity to detect occult hypertension, supine hypertension warrants greater attention,” they added.

SOURCE:

This study was led by Duc M. Giao, MD, of the Harvard Medical School in Boston. It was published online on January 22, 2025, in JAMA Cardiology.

LIMITATIONS:

The study population was younger than 65 years, limiting the generalizability to older age groups. The 20-minute supine rest period before blood pressure measurement exceeded typical clinic visit durations. This study did not account for nocturnal blood pressure measurements, and temporal effects between measurements may have influenced the findings. Moreover, a single baseline assessment and the use of different devices and methods for measurements in both positions may have constrained the findings.

DISCLOSURES:

The ARIC study was funded in whole or in part by grants from the National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute (NHLBI). Several authors reported receiving grants from various institutes such as the NIH, NHLBI, and National Institute of Neurological Disorders and Stroke.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.