Key result
Higher systolic blood pressure before standing and blunted recovery of systolic blood pressure during an active stand test were associated with increased all-cause mortality over 12 years (HR 1.14).
Why the study?
Individual components of dynamic heart rate and blood pressure responses to active stand associate with CVD and mortality, but whether integrating the entire haemodynamic response curve uncovers unknown associations remained unproven.
Do dynamic heart rate and blood pressure responses to an active stand test predict incident cardiovascular disease and mortality over 12 years?
Cohort (n=4,336)
Do dynamic heart rate and blood pressure responses to an active stand test predict incident cardiovascular disease and mortality over 12 years?
Hazard Ratio: 1.14 (95% CI 1.04–1.26)
p-value: p=0.007
Integrating the entire haemodynamic response curve to an active stand test can predict 12-year incident cardiovascular disease and mortality, serving as a potential marker of neuro-cardiovascular health.
Orthostatic BP responses may flag higher mortality risk; leaves open incremental value for risk stratification beyond standard measures.
BACKGROUND: An integrated haemodynamic response during standing may serve as a marker of neuro-cardiovascular function. Individual components of both heart rate (HR) and blood pressure (BP) responses to active stand (AS) have been linked with cardiovascular disease (CVD) and mortality. We hypothesised that integrating BP/HR information from the entire haemodynamic response curve may uncover otherwise unknown associations with both CVD and mortality. METHODS: Beat-to-beat measurements of dynamic HR/BP responses to AS were conducted in 4336 individuals (61.5 ± 8.2 years; 53.7% female). We assessed longitudinal associations between entire HR/BP response curves during AS, incident CVD and mortality over 12 years, and cross-sectional association with CVD on an independent clinical cohort. Functional Principal Components Analysis was applied to response curves, and their association with CVD and mortality was assessed. RESULTS: In multivariable models, components with higher systolic BP (SBP) before AS and blunted recovery of SBP during AS are associated with all-cause mortality over 12-years (Hazard Ratio [HR]: 1.14; 1.04, 1.26; p = 0.007). Components with higher baseline/peak HR and lower HR from 30 seconds post stand are associated with lower Hazard of cardiovascular deaths (HR: 0.78; 0.64, 0.95; p = 0.013). Impaired recovery of DBP from 35 seconds onward is associated with CVD in a validation cohort (Odds Ratio: 0.65; 0.17, 0.88). CONCLUSIONS: We observe distinct relationships between HR/BP responses to AS and 12-year incident CVD and mortality. BP recovery and CVD are also associated in an independent clinical validation cohort. Integrating the entire haemodynamic response may reveal more nuanced relationships between HR/BP responses to AS, CVD and mortality - serving as an integrative marker of neuro-cardiovascular health in midlife and beyond.
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Hernández et al. (2025) conducted a cohort in Cardiovascular disease and mortality (n=4,336). Higher systolic blood pressure before active stand and blunted recovery during active stand vs. Lower baseline systolic blood pressure and normal recovery was evaluated on All-cause mortality over 12 years (HR 1.14, 95% CI 1.04-1.26, p=0.007). Higher systolic blood pressure before standing and blunted recovery of systolic blood pressure during an active stand test were associated with increased all-cause mortality over 12 years (HR 1.14).
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