Abstract

Objective: It is known that blood pressure (BP) fluctuates with positioning of an individual. Usually BP falls when changing from lying to standing position which can cause orthostatic/postural hypotension. However, studies have also shown that BP rises in certain individuals from lying to standing position. Studies have also shown that rises are associated with increasing age, obesity and presence of diabetes. While the prevalence of orthostatic/postural hypotension is known, prevalence of rise in BP upon standing is not well documented. It is important to identify falls or rise in BP upon standing as orthostatic/postural hypotension is associated with increased risk of falls while a rise in BP is associated with increased risk of cardiovascular events (CV). The aim of our study is to examine the proportion of patients whose BP rises or falls upon standing amongst hypertensive patients. We also examined the association of age, diabetic status, obesity and CV with rises of BP upon standing. Materials and Methods: This is a cross sectional study of hypertensive patients in a primary care clinic. Demographic data was collected with weight and height measured. Sitting BP was taken twice after 5 minutes rest, standing BP was taken after 5 minutes of standing. Any fall or rise in BP from sitting to standing was categorized as fallers and risers respectively. Results: 1736 patients were recruited into this study,734 were invited to have their standing BP done. Mean age was 66.0 ± 9.9years, mean sitting systolic blood pressure (SBP) was 144.4 ± 19.1mmHg, mean sitting diastolic blood pressure (DBP) was 82.4 ± 10.9mmHg, mean sitting heart rate (HR) was 71.4 ± 12.6 min−1. Mean standing SBP was 146.0 ± 19.7mmHg, mean standing HR was 74.1 ± 13.3mins−1. Mean BMI was 27.1 ± 5.5 kg/m2, of which 69.5% (n = 437) were female, 51.6% (n = 379) were diabetic, and 25.3% (n = 378) were obese. Percentage of patients 65 years and older was 58.5% (n = 428). 22.5% (n = 164) of the patients also had prior CV events. The proportion of risers and fallers upon standing was 44.5% and 52.8% respectively. There was no significant difference between the proportion of risers and fallers with increasing age(p = 0.312) or diabetic status (p = 0.406). However, it was statistically significant associated with obesity (BMI of 30 kg/m2 or more)(p = 0.038). Conclusion: Although BP usually drops upon standing, our study showed more than half of treated hypertensives had a rise in their standing BP. There was association of risers/fallers with obesity but not with age or diabetes.

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