Among young and middle-aged adults with hypertension, a substantial rise in blood pressure upon standing may identify those with a higher risk of serious cardiovascular events, such as a stroke or heart attack.
The findings are published in the journal, Hypertension.
Paolo Palatini, M.D., lead author of the study and a professor of internal medicine at the University of Padova in Padova, Italy, said:
“This finding may warrant starting blood-pressure-lowering treatment including medicines earlier in patients with exaggerated blood pressure response to standing.”
Approximately 1 in 4 adults worldwide have high blood pressure. It is projected to affect more than 1.5 billion people around the world by 2025.
According to the American Heart Association’s 2022 heart disease statistics, people with hypertension in mid-life are five times more likely to have impaired cognitive function and twice as likely to experience reduced executive function, dementia and Alzheimer’s disease.
Typically, systolic (top number) blood pressure falls slightly upon standing up. In this study, researchers assessed whether the opposite response – a significant rise in systolic blood pressure upon standing – is a risk factor for heart attack and other serious cardiovascular events.
The researchers evaluated 1,207 people who were part of the HARVEST study, a prospective study that began in Italy in 1990 and included adults ages 18-45 years old with untreated stage 1 hypertension.
Stage 1 hypertension was defined as systolic blood pressure of 140-159 mm Hg and/or diastolic BP 90-100 mm Hg
None of the participants had taken blood pressure-lowering medication before the study and all the men were estimated to be low risk for major cardiovascular events.
At enrolment, participants were an average age of 33 years, 72 per cent were men, and all were white.
Six blood pressure measurements for each participant were taken in various physical positions at enrolment, including when lying down and after standing up.
The 120 participants with the highest rise (top 10 per cent) in blood pressure upon standing averaged an 11.4 mm Hg increase; all increases in this group were greater than 6.5 mm Hg.
The remaining participants averaged a 3.8 mm Hg fall in systolic blood pressure upon standing.
The researchers compared heart disease risk factors, lab measures and the occurrence of major cardiovascular events including stroke, heart attack and aneurysm of the aortic artery.
In some analyses, the development of atrial fibrillation, an arrhythmia that is a major risk factor for stroke, was also noted. Results were adjusted for age, gender, parental history of heart disease, and several lifestyle factors and measurements taken during study enrollment.
Platini said:
“The results of the study confirmed our initial hypothesis – a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure.
“We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run.”
