Increased pulse wave velocity in patients with an orthostatic blood pressure rise independent of other cardiovascular risk factors

Janis M. Nolde, Leslie Marisol Lugo-Gavidia, Dennis Kannenkeril, Justine Chan, Vance B. Matthews, Revathy Carnagarin, Omar Azzam, Márcio Galindo Kiuchi, Markus P. Schlaich

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Positional changes in blood pressure (BP) have been shown to have effects on long-term outcomes. Although a BP drop with upright posture is frequently observed, an orthostatic rise in BP can also occur. Here, we aimed to investigate whether the phenotype of orthostatic hypertension is associated with more pronounced vascular hypertension-mediated organ damage (HMOD) and whether this is associated with other cardiovascular risk factors. METHODS: In a cohort of 200 patients referred to our tertiary hypertension clinic, we prospectively assessed unattended seated automated office BP and the response to 1 min of upright posture. The difference in BP after standing up was calculated and pulse wave velocity (PWV) was assessed as a marker of vascular HMOD. Routine clinical cardiovascular risk markers were also assessed. Regression models were used to assess the association between orthostatic BP changes and pulse wave velocity. RESULTS: Baseline characteristics and clinic cardiovascular risk factors were similar between orthostatic BP response groups. A U-shaped association was evident between PWV and orthostatic BP changes with elevated PWV in patients with either a fall or a rise in BP in response to upright posture. The regression models remained significant after adjusting for other cardiovascular risk factors, including 24 h ambulatory BP. CONCLUSION: Both an orthostatic BP drop and rise were associated with elevated PWV. Although standing BP is commonly measured in elderly hypertensive patients to exclude significant orthostatic hypotension, this simple measurement may provide an additional independent risk factor for vascular HMOD at any age.

Original languageEnglish
Pages (from-to)1352-1360
Number of pages9
JournalJournal of Hypertension
Volume39
Issue number7
DOIs
Publication statusPublished - 1 Jul 2021

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