ORTHOSTATIC BLOOD PRESSURE CHANGES AND SUBCLINICAL MARKERS OF ATHEROSCLEROSIS IN NORMOTENSIVE ADULTS. RESULTS FROM A NATIONAL-REPRESENTATIVE SURVEY

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Objective: To evaluate the relationship between orthostatic upright postural blood pressure (BP) changes and subclinical markers of atherosclerosis in normotensive subjects using a simple 3-minutes standing up test. Design and method: A total of 1081 normotensive subjects enrolled in SEPHAR III national-representative survey, aged 18–80 years (42,4 ± 16.7 years, 55,3% females) underwent a simple 3 standing-up test involving BP measurement in supine position followed by BP measurements at 1 minute and 3 minutes after standing. We measured: aortic pulse wave velocity (PWVao) using a sfigmomanometric method (Arteriograph), body mass index (BMI), serum lipids, glyceated hemoglobin (HbA1c), urinary albumin-to-creatinine ratio (UACR) in morning spot urine and mean carotid intima-media thickness (IMT) by B-mode Doppler ultrasound. Orthostatic hypotension (OH) was defined by SBP decrease of at least 20mmHg and/or DBP decrease of at least 10mmHg, at 3 minutes after standing. Results: SBP and DBP increased when standing, with an average increase of SBP/DBP values when changing position of 3.7 ± 19.5 mm Hg / 9.6 ± 13.5 mm Hg at 1 minutes and 2.9 ± 19.2 mm Hg / 10.1 ± 13.2 mm Hg. Orthostatic hypotension (OH) was recoded in 130 subjects representing 12,4% of the study sample. The PWVao was significantly higher in OH subjects than in those without OH (9,12 ± 2.13m/s vs 8.08 ± 1.86m/s, p = 0,032). Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, HDL- cholesterol, LDL- cholesterol, fasting glucose, HbA1c, IMT, UACR and PWVao confirmed that PWVao, LDL-cholesterol and TG were independently related to orthostatic BP changes. Multiple regression analyses showed that age, baseline SBP, decrease in SBP at 3-minutes, BMI and fasting glucose were independent determinants of PWVao. Conclusions: Our results have shown that increased arterial stiffness is associated with OH during a 3- minutes standing-up test. Also, arterial stiffness may contribute to greater BP responses to postural changes from standing in normotensive subjects.