Key result
Orthostatic hypertension is linked to ~3-fold higher masked hypertension odds, and hypotension to white coat hypertension.
Why the study?
Exaggerated blood pressure response to orthostatic stimuli may be associated with masked and white coat hypertension, but this possible association needed clarification in a large general population.
Is orthostatic blood pressure change associated with masked and white coat hypertension in community residents?
Cross-Sectional (n=7,618)
Is orthostatic blood pressure change associated with masked and white coat hypertension in community residents?
Odds Ratio: 3.15
p-value: p=<0.001
Exaggerated postural blood pressure variability is physiologically associated with office-to-home blood pressure differences, specifically linking orthostatic hypertension to masked hypertension and orthostatic hypotension to white coat hypertension.
May flag masked or white coat hypertension during community screening; hypothesis-generating for orthostatic testing in hypertension phenotyping.
BACKGROUND: Exaggerated blood pressure (BP) response to orthostatic stimuli is indicative of cardiovascular frailty and may be associated with masked and white coat hypertension, which are BP abnormalities associated with cardiovascular outcomes. We aimed to clarify this possible association in a cross-sectional analysis of a large general population. METHODS: We enrolled 7618 community residents (mean age: 57.7 years). Orthostatic BP change was calculated as the difference between systolic BP measured in a seated position and at 3 min after standing. Orthostatic hypertension and hypotension were defined as >20 mmHg increase or decrease in systolic BP, respectively. Masked and white coat hypertension were defined based on office and home morning BP measurements. RESULTS: The frequency of orthostatic hypotension and hypertension was 1.8% and 1.6%, respectively. A significant association was observed between orthostatic BP change and office-to-home BP differences, that is, the greater the increase in orthostatic BP, the higher the home BP than the office BP. The association between orthostatic hypertension and masked hypertension (crude odds ratio: 3.15; P < 0.001) remained significant even after adjusting for potential covariates, including office seated BP. In addition, orthostatic hypotension was independently associated with white coat hypertension (crude odds ratio: 2.14; P = 0.002). Orthostatic BP change measured at 3 min showed a clearer association with masked and white coat hypertension than that measured at 1 min. CONCLUSION: We identified a physiological association between exaggerated postural BP variability and office-to-home BP differences, which were previously considered unrelated.
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Tabara et al. (2026) conducted a cross-sectional in Masked and white coat hypertension (n=7,618). Orthostatic blood pressure change (orthostatic hypertension or hypotension) vs. Normal orthostatic blood pressure response was evaluated on Masked hypertension (OR 3.15, p=<0.001). Orthostatic hypertension was significantly associated with masked hypertension (OR 3.15, P<0.001), and orthostatic hypotension was associated with white coat hypertension (OR 2.14, P=0.002).
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