Sharp rise in BP upon standing tied to elevated risk for CV, renal events
Young and middle-aged adults whose systolic BP rose at least 6.5 mm Hg upon standing were more likely to have CV and renal events later in life compared with others, researchers reported in Hypertension.
“This finding may warrant starting blood pressure-lowering treatment, including medicines, earlier in patients with exaggerated blood pressure response to standing,” Paolo Palatini, MD, professor of internal medicine at the University of Padova, Italy, said in a press release.
Palatini and colleagues analyzed 1,207 participants screened for stage 1 hypertension (mean age, 33 years; 73% men). All participants had six standing and six supine BP measurements taken during two visits.
In the cohort, compared with the lying position, BP in the standing position was and average of 2.5 mm Hg lower for systolic and 4.6 mm Hg higher for diastolic, according to the researchers.
Participants were designated as having hyperreactive to standing if their standing-supine systolic BP difference was in the top decile; the lower limit of the top decile was 6.5 mm Hg.
In 24-hour ambulatory BP readings, hypertension was more common in the group with orthostatic hyperreactivity than in the remainder of the cohort (90.8% vs. 76.4%; P = .001), according to the researchers.
In the 630 participants whose urinary catecholamines were measured, the epinephrine to creatinine ratio was higher in those with orthostatic hyperreactivity compared with others (118.4 nmol/mol vs. 77 nmol/mol; P = .005), Palatini and colleagues wrote.
“Epinephrine levels are an estimate of the global effect of stressful stimuli over the 24 hours. This suggests that those with the highest blood pressure when standing may have an increased sympathetic response [the fight-or-flight response] to stressors,” Palatini said in the release. “Overall, this causes an increase in average blood pressure.”
During mean follow-up of 17.2 years, there were 105 major CV or renal events in the cohort.
In a multivariate model, being a hyperreactor was an independent predictor of major CV and renal events (HR = 1.97; 95% CI, 1.1-3.52), the researchers wrote, noting the results did not change when ambulatory BP data and incident hypertension during follow-up were added to the model (HR = 1.94; 95% CI, 1.1-3.44).
“The results of the study confirmed our initial hypothesis — a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure. We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run,” Palatini said in the release. “The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood-pressure-lowering therapy may be considered for people with an elevated [hyperreactor] blood pressure response to standing,” he said.
Reference:
- If blood pressure rises upon standing, so may risk for heart attack. https://newsroom.heart.org/news/if-blood-pressure-rises-upon-standing-so-may-risk-for-heart-attack. Published on March 17, 2022. Accessed on March 17, 2022.
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