BACKGROUND Orthostatic hypertension is an emerging risk factor for adverse events. Recent consensus statements combine an increase in blood pressure upon standing with standing hypertension, but whether these 2 components have similar risk associations with cardiovascular disease (CVD) is unknown. METHODS The ARIC study (Atherosclerosis Risk in Communities) measured supine and standing blood pressure during visit 1 (1987-1989). We defined systolic orthostatic increase (a rise in systolic blood pressure [SBP] ≥20 mm Hg, standing minus supine blood pressure) and elevated standing SBP (standing SBP ≥140 mm Hg) to examine the new consensus statement definition (rise in SBP ≥20 mm Hg and standing SBP ≥140 mm Hg). We used Cox regression to examine associations with incident coronary heart disease, heart failure, stroke, fatal coronary heart disease, and all-cause mortality. RESULTS Of 11 369 participants (56% female; 25% Black adults; mean age, 54 years) without CVD at baseline, 1.8% had systolic orthostatic increases, 20.1% had standing SBP ≥140 mm Hg, and 1.3% had systolic orthostatic increases with standing SBP ≥140 mm Hg. During up to 30 years of follow-up, orthostatic increases were not significantly associated with any of the adverse outcomes of interest, while standing SBP ≥140 mm Hg was significantly associated with all end points. In joint models comparing systolic orthostatic increases and standing SBP ≥140 mm Hg, standing SBP ≥140 mm Hg was significantly associated with a higher risk of CVD, and associations differed significantly from systolic orthostatic increases. CONCLUSIONS Unlike systolic orthostatic increases, standing SBP ≥140 mm Hg was strongly associated with CVD outcomes and death. These differences in CVD risk raise important concerns about combining systolic orthostatic increases and standing SBP ≥140 mm Hg in a consensus definition for orthostatic hypertension.

中文翻译：

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直立性和站立性高血压以及心血管疾病风险。


背景 直立性高血压是不良事件的新兴危险因素。最近的共识声明将站立时血压升高与站立期高血压相结合，但尚不清楚这 2 个组成部分是否与心血管疾病 （CVD） 具有相似的风险关联。方法 ARIC 研究 （社区动脉粥样硬化风险） 测量了第 1 次就诊 （1987-1989） 期间的仰卧位和站立位血压。我们定义了收缩压直立性增加（收缩压 [SBP] 升高 ≥20 mm Hg，站立位减去仰卧位血压）和站立位 SBP 升高（站立位 SBP ≥140 mm Hg）以检查新的共识陈述定义（SBP 升高 ≥20 mm Hg，站立位 SBP ≥140 mm Hg）。我们使用 Cox 回归来检查与冠心病、心力衰竭、中风、致命性冠心病和全因死亡率的相关性。结果 在基线时无 CVD 的 11 369 名参与者 （56% 为女性;25% 为黑人成人;平均年龄为 54 岁）中，1.8% 的患者收缩期直立性增加，20.1% 的患者站立期 SBP ≥140 mm Hg，1.3% 的患者收缩期直立性增加，站立期 SBP ≥140 mm Hg。在长达 30 年的随访中，直立性增加与任何感兴趣的不良结局均无显著相关性，而站立 SBP ≥140 mm Hg 与所有终点显著相关。在比较收缩压直立性增加和站立期 SBP ≥140 mm Hg） 的联合模型中，站立期 SBP ≥140 mm Hg 与 CVD 风险增加显著相关，并且关联与收缩压直立性增加显著不同。结论 与收缩期直立性增加不同，站立 SBP ≥140 mm Hg） 与 CVD 结局和死亡密切相关。 CVD 风险的这些差异引发了对在直立性高血压的共识定义中将收缩期直立性增加和站立 SBP ≥140 mm Hg）相结合的重要担忧。