Abstract P316: Orthostatic Hypertension, Standing Hypertension, and Risk of Cardiovascular Disease

Abstract

Background: There is substantial controversy over how to define orthostatic hypertension (OHTN), an increase in blood pressure (BP) after standing. Recent consensus statements combine both orthostatic and standing hypertension. This could be problematic if their individual associations with cardiovascular disease (CVD) differed as one phenotype would subsume the risk attributes of the other. Objectives: To compare the association between OHTN or standing HTN with CVD. Methods: The Atherosclerosis Risk in Communities Study measured supine and standing BP during visit 1 (1987-1989). OHTN was defined as a rise in SBP ≥20 mm Hg or DBP ≥10 mm Hg (standing minus supine BP). We also examined a new consensus statement definition of a rise of ≥20 mm Hg in SBP (systolic OHTN) and standing SBP of ≥140 mm Hg. We excluded participants with a history of CVD. We determined risk associations with incident CHD, heart failure, stroke, fatal CHD, and all-cause mortality using Cox models adjusted for CVD risk factors (see Table footnote). Results: Of 11,369 participants (56% female, 25% Black adults, mean age 54 years), 10% had OHTN, 20% had standing systolic HTN, and 1% had systolic OHTN with standing SBP ≥140 mm Hg. Over a range of 25-28 years of follow-up, OHTN was not significantly associated with any of the outcomes, while standing systolic HTN was significantly associated with all outcomes. In joint models comparing systolic OHTN and standing HTN, standing HTN was significantly associated with CVD and associations differed significantly from systolic OHTN (Table). Conclusions: Unlike OHTN, standing HTN was strongly associated with CVD and death. These differences in CVD risk raise important concerns about combining OHTN and standing HTN in a consensus definition.