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Palatini P, Kollias A, Saladini F, Asmar R, Bilo G, Kyriakoulis KG, Parati G, Stergiou GS, Grassi G, Kreutz R, Mancia G, Jordan J, Biaggioni I, de la Sierra A. Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2024; 42:939-947. [PMID: 38647124 DOI: 10.1097/hjh.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.
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Affiliation(s)
- Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Francesca Saladini
- Cardiology Unit, Cittadella Town Hospital, Padova. Department of Medicine, University of Padova, Padova, Italy
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Grzegorz Bilo
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Monza, Italy
| | | | | | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Italo Biaggioni
- Autonomic Dysfunction Center and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alejandro de la Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
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Hage C, Sundström J, Lund LH. More Evidence That HF With Normal EF Is Distinct From HF Below Normal EF. J Am Coll Cardiol 2024; 83:1740-1742. [PMID: 38537914 DOI: 10.1016/j.jacc.2024.03.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Camilla Hage
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars H Lund
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Dorogovtsev VN, Yankevich DS, Gaydashev AE, Martyushev-Poklad AV, Podolskaya JA, Borisov IV, Grechko AV. Preclinical Orthostatic Abnormalities May Predict Early Increase in Vascular Stiffness in Different Age Groups: A Pilot Study. Diagnostics (Basel) 2023; 13:3243. [PMID: 37892064 PMCID: PMC10606479 DOI: 10.3390/diagnostics13203243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Clinical orthostatic hypotension (OH) and hypertension (OHT) are risk factors for arterial hypertension (AH) and cardiovascular diseases (CVD) and are associated with increased vascular stiffness. Preclinical OH and OHT are poorly understood. The main objective was to investigate preclinical orthostatic abnormalities and their association with increased vascular stiffness in different age groups of adults. A specially designed head-up tilt test standardized for hydrostatic column height was used to detect them. Three age groups of clinically healthy subjects were examined. In the group of young adults up to 30 years old, a significant predominance of orthostatic normotension (ONT) and an insignificant number of subjects with preclinical OH and OHT were found. In the age group over 45 years, compared to the group under 30 years, there was a twofold decrease in the proportion of individuals with ONT and a significant increase with preclinical OH and OHT. In all age groups, there was a significant orthostatic increase in vascular stiffness (as measured by the brachial-ankle pulse wave velocity (baPWV), which was recovered to the baseline level when returning to the supine position. Overall, subjects with preclinical OH and OHT had significantly higher baPWV values compared to those with ONT (p = 0.001 and p = 0.002, respectively), with all subjects having vascular stiffness values within normal age-related values.
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Affiliation(s)
- Victor N. Dorogovtsev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Dmitry S. Yankevich
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Andrey E. Gaydashev
- Problem Scientific Research Laboratory, Smolensk State Medical University, 214019 Smolensk, Russia;
| | - Andrey V. Martyushev-Poklad
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Julia A. Podolskaya
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Ilya V. Borisov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Andrey V. Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
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Abstract
The prognostic role and the clinical significance of orthostatic hypertension (OHT) remained undefined for long because data were sparse and often inconsistent. In recent years, evidence has been accumulating that OHT is associated with an increased risk of masked and sustained hypertension, hypertension-mediated organ damage, cardiovascular disease, and mortality. Most evidence came from studies in which OHT was defined using systolic blood pressure (BP) whereas the clinical relevance of diastolic OHT is still unclear. Recently, the American Autonomic Society and the Japanese Society of Hypertension defined OHT as an orthostatic systolic BP increase ≥20 mm Hg associated with a systolic BP of at least 140 mm Hg while standing. However, also smaller orthostatic BP increases have shown clinical relevance especially in people ≤45 years of age. A possible limitation of the BP response to standing is poor reproducibility. OHT concordance is better when the between-assessment interval is shorter, when OHT is evaluated using a larger number of BP readings, and if home BP measurement is used. The pathogenetic mechanisms leading to OHT are still controversial and may vary according to age. Excessive neurohumoral activation seems to be the main determinant in younger adults whereas vascular stiffness plays a more important role in older individuals. Conditions associated with higher activity of the sympathetic nervous system and/or baroreflex dysregulation, such as diabetes, essential hypertension, and aging have been found to be often associated with OHT. Measurement of orthostatic BP should be included in routine clinical practice especially in people with high-normal BP.
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Affiliation(s)
- Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padova, Italy
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Saz-Lara A, Cavero-Redondo I, Martínez-Vizcaíno V, Lucerón-Lucas-Torres M, Pascual-Morena C, Sequí-Domínguez I. Association between arterial stiffness and orthostatic hypotension: A systematic review and meta-analysis. Front Physiol 2023; 14:1164519. [PMID: 37250126 PMCID: PMC10210150 DOI: 10.3389/fphys.2023.1164519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Orthostatic hypotension, defined as a decrease in blood pressure on standing, is associated with an increased risk of mortality and cardiovascular events in the general population. In addition, it has recently been suggested that arterial stiffness is independently associated with orthostatic hypotension, which may be due to a loss of the buffering effect of the ascending aorta and an early return of pressure waves. However, the specific mechanisms underlying this association remain unclear. Thus, we aimed to evaluate the association between orthostatic hypotension and arterial stiffness in the adult population. Methods: PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from inception to 31 January 2022. The DerSimonian and Laird method was used to calculate pooled odds ratio (OR) estimates and their respective 95% confidence intervals (95% CI) for the association between orthostatic hypotension and arterial stiffness. Results: Overall, 11 studies were included, with a total of 10,611 subjects. Our results showed that increased arterial stiffness raises the risk of orthostatic hypotension (OR: 1.40, 95% CI: 1.28-1.54), with a stronger association at central arterial stiffness (OR: 1.50, 95% CI: 1.34-1.68) than at peripheral arterial stiffness (OR: 1.29, 95% CI: 1.17-1.43). Conclusion: Our findings showed that increased arterial stiffness raises the risk of orthostatic hypotension by 40% among the adult population. Considering that orthostatic hypotension, which is usually a consequence of antihypertensive treatment, has been widely associated with the risk of cardiovascular events, appropriate control of arterial stiffness could be a clinical strategy to prevent cardiovascular morbidity and mortality.
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Affiliation(s)
- Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Iván Cavero-Redondo
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
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Orthostatic hypotension and arterial stiffness: sources for potential bias. Blood Press Monit 2022; 27:408-410. [DOI: 10.1097/mbp.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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