Association between the blood pressure response to a change in posture and the 6-year incidence of hypertension: prospective findings from the ARIC study

Abstract

The association between the blood pressure response to a change from the supine to the standing position and the 6-year incidence of hypertension was studied in a biethnic, middle-aged cohort of 6951 normotensive men and women free of coronary heart disease at baseline. Postural change in systolic blood pressure (SBP) was categorized into deciles, and the middle four deciles served as the referent (no change) group. In unadjusted analyses, the incidence of hypertension was higher among both those with SBP increases and decreases relative to those in the referent group. Associations were modestly attenuated after controlling for age, ethnicity, and gender and cardiovascular disease risk factors. However, after adjustment for baseline, seated SBP, a modest association with incident hypertension persisted only for SBP decreases. Orthostatic hypotension (upon standing) was associated with incident hypertension and isolated systolic hypertension and, unexpectedly, this increased risk was highest among those with the lowest levels of baseline, resting SBP.

Quantitative genetic analysis of blood pressure reactivity to orthostatic tilt using principal components analysis

“…This approach thus overcomes some of the problems caused by the multicollinearity of study data that are inherent in epidemiological studies focusing on traditional measures of BP and BP during challenge. For example, in a study by Rose et al, 8 adjusting for baseline BP attenuated the association between future incident hypertension and both positive and negative BP reactivity to postural challenge. It is possible that Rose et al's findings may be owing to an overadjustment for baseline BP.…”

“…These findings contradict some studies examining BP response to postural change. For example, some studies have found that DSBP to postural change (standing) is influenced by cigarette smoking, 3,5 certain antihypertensive medication 8,43 and BMI. 3,5,8 However, other studies indicate that BP response to postural change is not influenced by cigarette smoking, 8,13,43 hypertensive medication 3,5 or BMI.…”

“…For example, some studies have found that DSBP to postural change (standing) is influenced by cigarette smoking, 3,5 certain antihypertensive medication 8,43 and BMI. 3,5,8 However, other studies indicate that BP response to postural change is not influenced by cigarette smoking, 8,13,43 hypertensive medication 3,5 or BMI. 4,13 It is possible that the covariate effects observed in some of these studies are influenced or obfuscated by multicollinearity among BP measures, and that the observed significant covariate effect may reflect an association with the portion of the variance of BP reactivity that is correlated with resting or general BP.…”

“…Three PC extracted fromIntroduction Exaggerated blood pressure (BP) reactivity to physiological stressors may be predictive of coronary heart disease, 1-4 stroke 5 and hypertension. [6][7][8] However, not all studies have reached the same conclusion. 9,10 One reason for these equivocal results is the fact that genetic factors are rarely accounted for in studies of BP reactivity.…”

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

“…OH has been shown to occur well in advance of CVD, even preceding some CVD risk factors, such as hypertension 39. Furthermore, sudden recurrent decreases in BP with standing could contribute to end‐organ damage.…”