Objective: In routine care, hypertension is typically diagnosed using non-invasive brachial cuff blood pressure measurements obtained in the seated position. However, emerging data suggest that blood pressure assessed in the supine posture may yield additional prognostic information.Design and method: This work synthesises recent evidence regarding the effects of body position on blood pressure values and cardiovascular risk estimation across office, ambulatory, and home monitoring modalities (OBPM, ABPM, HBPM) with focus on clinical implications and priorities for future investigation. Results: Within office-based measurements, individuals exhibiting elevated blood pressure exclusively in the supine position showed a cardiovascular risk comparable to those hypertensive in both seated and supine postures, and a higher risk than those with isolated seated hypertension. The prognostic relevance of supine hypertension appeared particularly pronounced in patients younger than 65 years. In ambulatory monitoring, nocturnal hypertension and impaired dipping patterns remain the most robust predictors of cardiovascular events, especially when measurements correspond to confirmed sleep periods. In contrast, supine nocturnal home blood pressure monitoring has not yet been systematically studied. Despite these findings, routine clinical assessment continues to rely predominantly on seated measurements. Conclusions: Recent investigations indicate that incorporating supine office blood pressure may enhance cardiovascular risk stratification. These observations may partially account for the persistent prognostic strength of nocturnal blood pressure derived from ABPM or advanced HBPM devices, beyond associations with sleep-disordered breathing. Future research should aim to integrate supine blood pressure into composite risk models alongside seated measurements, and outcome trials should prospectively evaluate its additive value. Guideline committees may need to consider structured implementation of supine blood pressure assessment in light of its emerging prognostic relevance.
Pilz et al. (Fri,) studied this question.