The magnitude of increase in systolic blood pressure in response to the shift from supine to upright posture is considered to reflect the adequacy of orthostatic regulation. Orthostatic integrity is largely maintained by the interaction between the skeletal muscle pump, neurovascular compensation, neurohumoral effects, and cerebral blood flow regulation. Various physiological states and disease conditions may disrupt these mechanisms as seen in vasovagal syncope, dysautonomic orthostatic intolerance, and postural orthostatic tachycardia syndrome. Orthostatic hypotension (OH) and decreased cerebral blood flow are strongly related. Even subclinical OH has been associated to different degrees with impaired cognitive function, decreased effort, reduced motivation, increased hopelessness, and signs of attention-deficit hyperactivity disorder and dementia, diabetes mellitus, and Parkinson disease. Furthermore, subclinical levels of inadequate blood pressure regulation in response to orthostasis have been linked to increased depression and anxiety and intergenerational behavioral sequelae between mother and child. Identifying causes of subclinical and clinical OH is critical in improving quality of life for both children and older adults. A better understanding of the underlying causes responsible for the etiology of OH could lead to a rational design of novel effective therapeutic regimens for the treatment of this condition and associated comorbidities.

Identifying possible causes and consequences of subclinical and clinical OH are critical in improving quality of life for both children and older adults.

When changing posture from supine to standing, an increase in systolic blood pressure (SBP) is necessary for optimal orthostatic blood pressure (BP) regulation. Poor orthostatic BP regulation has been correlated with negative mood and behavioral sequelae in adults and children. This may be explained by the common neurobiological mechanism associated with cardiovascular functioning and anxiety. This study examined orthostatic BP regulation -indicated by SBP change -in healthy Caucasian and African American children aged 7-10 years. A multiple regression analysis was used to assess pediatric SBP change and state and trait anxiety in children and their mothers. Results revealed that higher state anxiety levels in children were associated with less effective SBP change. More importantly, higher maternal trait anxiety was also associated with less effective SBP in children. Trait and state anxiety may each have distinct links to orthostatic BP regulation, warranting further investigation of these processes across the lifespan.