Orthostatic Hypertension A Measure of Blood Pressure Variation for Predicting Cardiovascular Risk

Abstract

lderly patients with hypertension have various blood pressure (BP) regulation disorders, which are associated with the progression of target organ damage and cardiovascular risk. 1,2 One of these disorders is orthostatic BP dysregulation. In general, orthostatic BP dysregulation presents as the clinical problem "orthostatic hypotension". Orthostatic hypotension is well-recognized as a risk for falls, syncope, and cardiovascular events. 3,4 In contrast, "orthostatic hypertension", which is an increase in BP upon standing, has been infrequently reported. However, studies in recent years have shown that orthostatic hypertension is a new cardiovascular risk factor. [5][6][7][8][9] This review introduces the latest results on orthostatic hypertension, discusses its present status, and provides a new viewpoint. Definition and Prevalence of Orthostatic HypertensionOrthostatic hypotension is generally defined as a decrease in systolic BP (SBP) of at least 20 mmHg upon standing, whereas no consensus has been reached on the definition of orthostatic hypertension. In addition, various examination methods have been used in previous studies for the diagnosis of orthostatic hypertension.A previous study using the active standing test, in which orthostatic hypertension was defined as an increase (mean of increases after 1 and 2 min) of at least 20 mmHg from the BP in the lying position (mean value of 2 measurements) and orthostatic hypotension as a decrease of at least 20 mmHg, showed incidences of 8.7% and 6.0%, respectively, in general subjects. 6 In the Coronary Artery Risk Development in Young Adults (CARDIA) study, young adults were classified according to SBP changes upon standing into groups with orthostatic hypotension (a decrease >5 mmHg), no BP change (from -5 to +5 mmHg), and orthostatic hypertension (an increase >5 mmHg), and the incidences of orthostatic hypotension and hypertension in 2,781 young adults were 26.6% and 16.2%, respectively. 7 In another study, orthostatic hypertension was defined as both BP in the lying position <140/90 mmHg and BP after 1-min standing ≥140/90 mmHg, and the incidence of orthostatic hypertension in 277 diabetic patients (12.6%) was significantly higher than that in 110 non-diabetic controls (1.8%). 8 We performed a 70° head-up tilt (HUT) test for 15 min after a 10-min supine rest. The orthostatic increase in BP (mean SBP from 6 to 10 min after tilting-SBP during 5 min before tilting) was calculated, and SBP increase ≥20 mmHg was defined as orthostatic hypertension and an SBP decrease ≥20 mmHg was defined as orthostatic hypotension. 9 The incidences of orthostatic hypertension and hypotension in elderly patients with hypertension were 11% and 9.5%, respectively. New Device for Evaluating Orthostatic BP Dysregulation at HomeBecause orthostatic BP changes are markedly affected by the circulating blood volume, their reproducibility is considered to be poor. Therefore, it is optimal to diagnose orthostatic hypertension by performing the orthostatic test more than once. However, in daily ...

Prevalence of Orthostatic Hypertension in Elderly Patients with Type 2 Diabetes

“…Data on OHT are not well characterized in the literature and its real clinical significance is unknown, although some studies carried out in recent years have suggested that orthostatic hypertension may be a new cardiovascular risk factor [ 11 ].…”

An Emerging Role for Understanding Orthostatic Hyp‘er’tension in the Cardiorenal Syndrome

“…Ambulatory BP has been identified as a measure of cardiovascular morbidity independent of clinical BP recording [42]. Newer models of ambulatory BP monitors have been designed, which have a body position sensor and measure BP twice in the sitting and standing positions automatically [7]. The results from ambulatory BP monitoring are more accurate and reproducible.…”

“…OHT has also been referred to as ‘postural hypertension’ in the past [3]. Over the last few years, there has been an increased interest in OHT as it has been found to be associated with increased risk of developing hypertension in young adults [4], silent cerebral infarcts in elderly hypertensives, and myocardial ischemia and proteinuria [5,6,7]. Therefore, we will review the current understanding of the pathogenesis, definitions, clinical implications, and possible available treatment options in the context of the cardiorenal metabolic syndrome (CRS).…”

The Association between Within-Visit Blood Pressure Variability and Carotid Artery Atherosclerosis in General Population

“…BP is a highly variable physiologic trait, its fluctuations being the result of a complex interaction between environmental stimuli and the response of cardiovascular control mechanisms [8], [9], [17], [18], [19], [20]. BP variability can be classified into long-term and short-term variability, the latter being characterized by spontaneous variation within a 24-hour period.…”

“…In these studies, within-visit BP variability was described as either a weak or insignificant predictor of vascular events [5], [6]. In contrast to visit-to-visit BP variability, within-visit BP variability obtained during a single visit as an indicator reflecting a transient fluctuation of BP over a very short period has been applied more to evaluate the variation in emotional and sympathetic activity, with previous research showing a link between a highly active sympathetic nervous system and increased cardiovascular risk [8], [9]. Although a possible potential mechanism had been reported whereby increased variability in BP might increase intra-vascular pressure or shear force, subsequently causing endothelial function damage and promoting the development of atherosclerosis [10], [11], it has remained uncertain whether within-visit BP variability plays a role in the process of atherosclerosis.…”