Abstract P347: Utility Of Standing Blood Pressure On Blood Pressure Control In Treated Hypertension

Abstract

Many hypertension (HTN) guidelines have recommended routine measurement of standing BP in HTN adults at risk of orthostatic hypotension, especially in older adults. However, the incremental value of adding standing BP to seated BP in predicting HTN control has not been studied. Accordingly, we assessed BP in both seated and standing positions in 319 HTN adults treated with antihypertensive medications. Adequate BP control was defined as 24-Hr ABPM ≤125/75 or daytime ABPM ≤130/80 mmHg. Area under receiver operator characteristic curve (AUROC) was used to determine accuracy of seated and standing BP in assessing BP control. Bayes factor (BF) was used to assess the significant difference between AUROCs. Sensitivity and specificity of standing BP were derived using cutoffs derived from Youden’s Index. Overall mean age was 64±13 years, with 55% women (176 of 319), and 27% Black (86 of 319). Sensitivity and specificity of seated SBP were 75% and 60%, respectively, when HTN control was defined by 24-Hr ABPM. Optimal cutoffs for standing BP were 138/86 and 142/86 mmHg (based on 24-Hr SBP and daytime SBP as gold standard, respectively). Sensitivity and specificity of standing SBP were 54% and 81%, respectively, when using the cutoff derived from 24-Hr ABPM. The AUROCs of standing SBP and DBP were not significantly different compared to seated when HTN control was defined by 24-Hr or daytime ABPM. Similarly, the addition of standing to seated BP was not significantly different when compared to seated BP based on both references (Figure 1: A-B). In conclusion, routine incorporation of standing office BP did not offer additional value in determining adequacy of BP control among treated HTN patients.