Orthostatic Rises in SBP Not Tied to Increased CVD

TOPLINE:

Among middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) study, standing hypertension (systolic blood pressure [SBP] ≥ 140 mm Hg when standing) is associated with an increased risk for cardiovascular disease (CVD), whereas orthostatic increases in SBP do not show a significant association.

METHODOLOGY:

• Recent consensus statements recommend defining orthostatic hypertension to include both orthostatic increases in SBP (≥ 20 mmHg) and standing hypertension; however, questions remain about whether these components have distinct associations with CVD.
• Researchers evaluated these respective associations in a prospective cohort analysis using data from the ARIC study.
• They included 11,369 participants without CVD at baseline (mean age, 53.9 years; 56% women; 25% Black individuals) who were enrolled between 1987 and 1989 from four US communities.
• BP was measured in both supine and standing positions at the first visit to assess orthostatic increases in SBP (≥ 20 mmHg) or diastolic BP (≥ 10 mmHg) when moving from a supine to standing position, and standing hypertension.
• The primary outcomes were incident coronary heart disease, heart failure, stroke, fatal coronary heart disease, and all-cause mortality, assessed over a median follow-up ranging from 24 to 28 years.

TAKEAWAY:

• Standing SBP ≥ 140 mm Hg was associated with a higher risk for coronary heart disease (adjusted hazard ratio [aHR], 1.46; 95% CI, 1.32-1.60), heart failure (aHR, 1.60; 95% CI, 1.46-1.75), stroke (aHR, 1.68; 95% CI, 1.46-1.92), fatal coronary heart disease (aHR, 1.82; 95% CI, 1.52-2.16), and all-cause mortality (aHR, 1.29; 95% CI, 1.21-1.37).
• Orthostatic increases in SBP (≥ 20 mm Hg were not associated with significant increases in any CVD outcome but did show an inverse association with heart failure (aHR, 0.85; 95% CI, 0.74-0.97).
• The combination of orthostatic increase in SBP and standing hypertension was associated with a higher risk for stroke (aHR, 1.65; 95% CI, 1.12-2.43).
• In models with both orthostatic increases in SBP and standing hypertension, systolic orthostatic increase was associated with a lower risk for coronary heart disease (aHR, 0.63; 95% CI, 0.45-0.89), whereas standing systolic BP ≥ 140 mm Hg was positively associated with all CVD outcomes.

IN PRACTICE:

“Contrary to the recent consensus definition, this finding underscores the importance of distinguishing between orthostatic increases and standing SBP [systolic BP] ≥ 140 mm Hg in clinic care and subsequent research,” the authors wrote. “[The study] findings raise concerns about combining these two components into a single definition, as the two may have distinct risk factors, underlying physiology, and downstream implications for CVD,” they further added.

SOURCE:

The study was led by Sean W. Dooley, Beth Israel Deaconess Medical Center, Boston. It was published online on December 05, 2024, in Hypertension.

LIMITATIONS:

A relatively low prevalence of orthostatic increases and standing hypertension may have affected the power to detect associations. The findings are based on a middle-aged cohort, which may not be generalizable to older populations in whom orthostatic increases are more prevalent. The analysis relied on a single visit for standing BP measurements; repeated assessments could provide more robust data. The study was observational in nature and hence may be subject to potential residual confounding.

DISCLOSURES:

The ARIC study was funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute; National Institutes of Health; and Department of Health and Human Services. The authors reported no relevant conflicts of interest.

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