Body Position and Orthostatic Hypotension in Hypertensive Adults: Results from the Syst-Eur Trial

Abstract

BACKGROUND: We recently demonstrated that more intensive blood pressure (BP) treatment lowered risk of orthostatic hypotension (OH) measured with a seated-to-standing protocol. However, seated-to-standing OH assessments are less sensitive than supine-to-standing and could miss clinically relevant OH. OBJECTIVES: Using data from the Syst-Eur trial (Systolic Hypertension in Europe), we examined the effect of hypertension treatment on incidence of OH based on the difference in BP from 3 body positions. METHODS: Syst-Eur was a multi-center, randomized trial that enrolled adults with isolated systolic hypertension to investigate whether active hypertension treatment could reduce cardiovascular events. Participants underwent BP measurement in supine, seated, and standing positions. Using differences in BP between the 3 body positions (seated minus supine, standing minus seated, and standing minus supine), we defined OH as a drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg. We included measurements from baseline and follow-up visits. RESULTS: Among 4695 participants (mean age, 70.2±6.7 years; 66.9% female) with 42 636 BP measurements, OH was present in 4.9% of measures with supine-to-seated, 7.9% with seated-to-standing, and 11.4% with supine-to-standing protocols, respectively. Compared with placebo, BP treatment did not increase OH with any set of maneuvers, OR, 0.79 (95% CI, 0.65–0.95) with seated-to standing, 1.03 (95% CI, 0.86–1.24) with supine-to-seated, and 0.99 (95% CI, 0.86–1.15) with supine-to-standing. CONCLUSIONS: Regardless of protocol, active hypertension treatment did not increase the risk of OH, reinforcing evidence that OH should not be viewed as a complication of hypertension treatment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02088450.

Condition of the autonomic nervous system during the 'sit-stand-sit' orthostatic test in university students in areas of military conflict in Ukraine

“…Moreover, our findings are in line with the research of Grobman et al [20], Juraschek et al [21], and Earle et al [22], advocating for the application of orthostatic tests in diverse configurations to evaluate physical stress adaptation. This highlights the necessity of consistent evaluation of the autonomic nervous system in students, particularly under heightened stress scenarios like wartime conditions.…”

“…In these circumstances, employing tests like 'supine to standing' and 'seated to standing' in different variations is advised. This method is recommended in several research papers [20,21,22], highlighting the need to evaluate the autonomic nervous system in college students, particularly under challenging conditions such as warfare, pandemics, and virtual education. This approach aids in comprehensively grasping and alleviating the effects of these situations on students' autonomic nervous health.…”

Utility of standing office blood pressure in detecting hypertension in healthy adults

“…Excessive neurohormonal activation and sympathetic overactivity may be responsible for this observation 18 , 30 . Likewise, orthostatic hypotension, defined as a reduction in SBP of ≥ 20 or a reduction in DBP of ≥ 10 mmHg one minute after standing from a seated position, has also been shown to be associated with increased cardiovascular mortality 15 , 31 – 33 . Taken into context, our results highlight that by obtaining standing office BPs, a clinician can also utilize the advantage of increasing diagnostic accuracy for hypertension in addition to the important prognostic information provided.…”

Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association

“…77 Large hypertension treatment trials have used seatedto-standing rather than supine-to-standing BP protocols to detect OH. 19,20,63,78 Seated-to-standing protocols are included as an alternative method in many society guidelines, 16 and are more practical and easier to implement, particularly in ambulatory clinics and large clinical trials, but at the cost of decreased sensitivity 79 because OH is diagnosed more frequently from supine than from seated positions. 24,37,73,[80][81][82][83] Moreover, 1 study found that only supine-to-standing OH was associated with falls and orthostatic symptoms in adults ≥70 years of age (62% hypertensive).…”