What does this research mean for the field?

Both orthostatic hypertension and orthostatic hypotension are independently associated with an increased prevalence of silent cerebral infarcts in elderly hypertensive patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the association between orthostatic blood pressure changes and the presence of silent cerebrovascular disease in elderly hypertensive individuals.

September 16, 2026Journal of the American College of CardiologyOpen Access

U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives

Q: What are the key findings of this study?

Orthostatic hypertension and hypotension in elderly hypertensives were associated with more silent cerebral infarcts (3.4 and 2.7 per person) than normal orthostatic response (1.4 per person).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Sustained hypertension (n=241). Intervention: Orthostatic hypertension (OHT) or hypotension (OHYPO) vs. Normal orthostatic blood pressure response. Primary outcome: Silent cerebral infarcts per person (p=<0.0001).

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Key result

Orthostatic hypertension and hypotension linked to ~2-fold more silent cerebral infarcts vs normal response.

P<0.0001
n=241

Why the study?

Does orthostatic blood pressure dysregulation (OHT or OHYPO) increase the risk of silent cerebrovascular disease in elderly hypertensives?

Key Points

To determine the association between orthostatic blood pressure changes and the presence of silent cerebrovascular disease in elderly hypertensive individuals.
Measured postural blood pressure responses during transitions from supine to upright standing positions in elderly hypertensive individuals.
Evaluated silent cerebrovascular disease, including silent cerebral infarcts and white matter lesions, using brain magnetic resonance imaging.
Demonstrated a U-shaped relationship in which both marked orthostatic blood pressure drops and marked surges were associated with a higher prevalence of silent cerebral infarction.
Observed that excessive postural blood pressure fluctuations correlate with impaired cerebral hemodynamic regulation and heightened microvascular damage.

Study Design

Type

Observational (n=241)

Structured PICO

Does orthostatic blood pressure dysregulation (OHT or OHYPO) increase the risk of silent cerebrovascular disease in elderly hypertensives?

Population

241 elderly subjects with sustained hypertension evaluated for orthostatic blood pressure changes and silent cerebrovascular disease.

Exposure

Orthostatic blood pressure dysregulation during head-up tilting test, specifically orthostatic hypertension (OHT, orthostatic increase of systolic blood pressure ≥20 mm Hg) or orthostatic hypotension (OHYPO, orthostatic systolic blood pressure decrease ≥20 mm Hg).

Comparator

Normal orthostatic blood pressure response (neither OHT nor OHYPO).

Outcome

Silent cerebral infarcts assessed by brain magnetic resonance imaging (MRI).surrogate

Main Result

Absolute Event Rate: 3.4% vs 1.4%

p-value: p=<0.0001

Discussion

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Implication

Both orthostatic hypertension and orthostatic hypotension are associated with an increased burden of silent cerebral infarcts in elderly hypertensive patients, demonstrating a U-curve relationship.

Cite This Study

Kario et al. (2002) conducted an observational in Sustained hypertension (n=241). Orthostatic hypertension (OHT) or hypotension (OHYPO) vs. Normal orthostatic blood pressure response was evaluated on Silent cerebral infarcts per person (p=<0.0001). Orthostatic hypertension and hypotension in elderly hypertensives were associated with more silent cerebral infarcts (3.4 and 2.7 per person) than normal orthostatic response (1.4 per person).

synapsesocial.com/papers/6aaab2b8c8c118f90db3c99f https://doi.org/10.1016/s0735-1097(02)01923-x

Topics

Hypertension management

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Implication

Both orthostatic hypertension and orthostatic hypotension are associated with an increased burden of silent cerebral infarcts in elderly hypertensive patients, demonstrating a U-curve relationship.

U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider