Orthostatic Blood Pressure Transitions: Association with Symptoms and Frailty

Objective: Individuals with hypertension may transition between different orthostatic blood pressure (BP) phenotypes within minutes. We studied the temporal patterns of orthostatic BP responses and their relationship to symptom development in older hypertensive individuals with and without frailty. Design and method: A cross-sectional study was conducted including patients aged ?60 years. BP was measured seated and at 1- and 3-minutes post-standing. Orthostatic hypotension (OH) and orthostatic hypertension (OHT) were defined in accordance with current guidelines. Orthostatic intolerance (OI) was defined as symptoms upon standing. Frailty was assessed using the Clinical Frailty Scale. Multivariable logistic regression models evaluated associations between orthostatic BP phenotypes, OI and Frailty. Results: We included 461 hypertensive adults (mean age: 72.5 ± 7.0 years, 70% female). The prevalence of OH and OHT was 11% and 10%, respectively. About 50% of individuals with OH or OHT at minute 1 normalized their BP by minute 3, while a similar absolute number with normal BP at minute 1 developed OH or OHT by minute 3. Frail individuals exhibited a twofold higher prevalence of OH (OR 2.39, p = 0.023), and a more than threefold higher prevalence of OHT (OR 3.60, p < 0.001). In fully adjusted models, OI was associated with both systolic OH (OR 3.05, p = 0.019) and OHT (OR 2.33, p = 0.041). Conclusions: Orthostatic BP phenotypes in hypertensive older adults were dynamic, with frequent shifts between 1 and 3 minutes of standing. Frailty and OI were strongly associated not only with OH but also with OHT.