Key result
Orthostatic hypertension is associated with an increased risk of masked and sustained hypertension, hypertension-mediated organ damage, cardiovascular disease, and mortality.
Why the study?
The prognostic role and clinical significance of orthostatic hypertension remained undefined for long due to sparse and inconsistent data.
What is the clinical significance and prognostic role of orthostatic hypertension?
What is the clinical significance and prognostic role of orthostatic hypertension?
Orthostatic hypertension is a clinically relevant phenotype associated with increased cardiovascular risk, and its measurement should be included in routine clinical practice, particularly for individuals with high-normal blood pressure.
May warrant orthostatic BP assessment in high-normal BP; leaves open whether routine measurement improves outcomes.
The prognostic role and the clinical significance of orthostatic hypertension (OHT) remained undefined for long because data were sparse and often inconsistent. In recent years, evidence has been accumulating that OHT is associated with an increased risk of masked and sustained hypertension, hypertension-mediated organ damage, cardiovascular disease, and mortality. Most evidence came from studies in which OHT was defined using systolic blood pressure (BP) whereas the clinical relevance of diastolic OHT is still unclear. Recently, the American Autonomic Society and the Japanese Society of Hypertension defined OHT as an orthostatic systolic BP increase ≥20 mm Hg associated with a systolic BP of at least 140 mm Hg while standing. However, also smaller orthostatic BP increases have shown clinical relevance especially in people ≤45 years of age. A possible limitation of the BP response to standing is poor reproducibility. OHT concordance is better when the between-assessment interval is shorter, when OHT is evaluated using a larger number of BP readings, and if home BP measurement is used. The pathogenetic mechanisms leading to OHT are still controversial and may vary according to age. Excessive neurohumoral activation seems to be the main determinant in younger adults whereas vascular stiffness plays a more important role in older individuals. Conditions associated with higher activity of the sympathetic nervous system and/or baroreflex dysregulation, such as diabetes, essential hypertension, and aging have been found to be often associated with OHT. Measurement of orthostatic BP should be included in routine clinical practice especially in people with high-normal BP.
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Paolo Palatini (2023) conducted a review in Orthostatic hypertension. Orthostatic hypertension was evaluated. Orthostatic hypertension is associated with an increased risk of masked and sustained hypertension, hypertension-mediated organ damage, cardiovascular disease, and mortality.
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