Disorders of Orthostatic Blood Pressure Response Are Associated With Cardiovascular Disease and Target Organ Damage in Hypertensive Patients

TLDR

Orthostatic hypertension’s prevalence and clinical significance in hypertensive patients remain largely undetermined. This study examined whether orthostatic hypertension and orthostatic hypotension are associated with cardiovascular disease and target organ damage in hypertensive individuals. A cross‑sectional analysis of 4,711 hypertensives and 826 normotensives aged 40–75 defined orthostatic hypertension as a systolic rise ≥20 mmHg and orthostatic hypotension as a systolic drop ≥20 mmHg or diastolic drop ≥10 mmHg within three minutes of standing. Hypertension independently predicts orthostatic hypertension, whereas orthostatic hypotension is associated with peripheral artery disease, left ventricular hypertrophy, coronary artery disease, and stroke, with a J‑shaped link between orthostatic systolic change and PAD in untreated hypertensives and LVH in women; the relationship between orthostatic hypertension and target organ damage requires prospective confirmation.

Abstract

The prevalence and clinical significance of orthostatic hypertension (OHT) remain largely undetermined in hypertensive patients. This study investigated the association of OHT and orthostatic hypotension (OH) with cardiovascular disease (CVD) and target organ damage (TOD) in hypertensive patients. A cross-sectional study was conducted in 4,711 hypertensives and 826 normotensives, aged 40–75 years. OHT was defined as an increase in systolic blood pressure (SBP) of ≥20mmHg, and OH was defined as either a reduction in SBP of at least 20mmHg or a reduction in diastolic BP (DBP) of at least 10mmHg during the first 3min after standing. Hypertension was only independently associated with a risk of OHT. After controlling for age, sex, and other confounders, OH was associated with peripheral artery disease (PAD) (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.15–1.89, P < 0.01), left ventricular hypertrophy (LVH) (OR 1.48, 95% CI 1.12–1.93, P < 0.001), coronary artery disease (CAD) (OR 1.71, 95% CI 1.12–2.61, P < 0.01), and stroke (OR 1.72, 95% CI 1.19–2.34, P < 0.01), but OHT was only associated with PAD (OR 1.36, 95% CI 1.05–1.81, P < 0.05) and stroke (OR 1.76, 95% CI 1.27–2.26, P < 0.01). The adjusted OR for PAD, predicted by the quintiles of the orthostatic SBP changes, showed a J-shaped relationship in untreated hypertensive patients, as was also the case for LVH in hypertensive women. OH is associated with CV risk; the associations of OHT with TOD and stroke in hypertensive patients still need to be confirmed in prospective studies.