The study's lead author, Dr.
Paolo Palatini, professor of internal medicine at the University of Padova in Italy, said: "This finding may justify early initiation of antihypertensive treatment, including medication, in patients with exaggerated blood pressure responses on standing
.
"
Nearly half of Americans and about 40 percent of the world's population suffer from high blood pressure, which is considered the world's leading preventable cause of death
.
According to the American Heart Association's 2022 Heart Disease Statistics, middle-aged people with high blood pressure are five times more likely to have impaired cognitive function, decreased executive function, dementia and Alzheimer's disease ( Alzheimer's disease) is twice as likely as normal
.
Typically, systolic blood pressure (upper limit) drops slightly while standing
.
In this study, the researchers assessed whether the opposite response -- a marked increase in systolic blood pressure while standing -- is a risk factor for heart attack and other serious cardiovascular events
.
The researchers evaluated 1,207 people who participated in the HARVEST study
.
The HARVEST study is a prospective study that began in Italy in 1990 in untreated adults 18-45 years of age with stage 1 hypertension
.
Stage 1 hypertension was defined as a systolic blood pressure of 140 - 159 mmHg and/or a diastolic blood pressure of 90 - 100 mmHg
.
There were no blood pressure lowering medications before the study, and all were initially estimated to be at low risk based on their life>
.
At the time of registration, the average age of the participants was 33 years, 72% were male, and all were white
.
At enrollment, each participant had blood pressure measured six times in different body positions, including after lying down and standing up
.
The 120 participants with the highest blood pressure increases (the top 10 percent) had a mean increase of 11.
4 mmHg while standing; all patients in this group had blood pressure increases greater than 6.
5 mmHg
.
The remaining subjects experienced an average drop in systolic blood pressure of 3.
8 mmHg while standing
.
The researchers compared the two groups of participants for heart disease risk factors, laboratory measures, major cardiovascular events (heart attack, heart-related chest pain, stroke, aortic aneurysm, peripheral artery occlusion), and chronic kidney disease
.
In some analyses, the development of atrial fibrillation, a cardiac arrhythmia, was also noted as a major risk factor for stroke
.
Results were adjusted for age, sex, parental history of heart disease, some life>
.
During a mean follow-up of 17 years, 105 major cardiovascular events occurred
.
The most common are heart attack, heart-related chest pain, and stroke
.
The top 10% have elevated blood pressure:
Almost twice as likely to have major cardiovascular disease as the other participants;
There was generally no higher risk of cardiovascular events (exaggerated blood pressure response while standing) at initial assessment;
more likely to be smokers (32.
1% vs 19.
9% in the non-rising group), but with comparable levels of physical activity, they were less likely to be overweight or obese, and less likely to have a family history of cardiovascular events;better cholesterol levels (lower total cholesterol, higher HDL cholesterol);
Systolic blood pressure was lower when lying down than in the other group (140.
5 mm Hg and 146.
0 mm Hg, respectively), while blood pressure measurements over 24 hours were higher
.
Exaggerated blood pressure response on standing remained an independent predictor of adverse cardiac events or stroke after adjusting for 24-hour mean blood pressure
.
"The findings confirm our original hypothesis that a significant increase in blood pressure from lying to standing is important for prognosis in hypertensive young adults
.
We were rather surprised that even the relatively small increase in standing blood pressure ( 6-7 mm Hg), also predicts major cardiac events in the long term
.
Among
the 630 participants who were tested for stress hormones in 24-hour urine samples, those with elevated blood pressure had higher adrenaline/creatinine ratios than those without elevated blood pressure (118.
4 nmol/mol and 77.
0 nmol/mol)
.
"Adrenaline levels are an estimate of the overall effect of stressful stimulation over a 24-hour period
.
This suggests that those with the highest blood pressure while standing may have a stronger sympathetic response (fight or flight response) to the stressor," Palatini said
.
"Overall, this leads to an increase in mean blood pressure
.
"
"Research suggests that blood pressure stations should be measured in order to tailor treatment in hypertensive patients, and it is possible that more aggressive life>
.
The findings of this study may not apply to people from other racial or ethnic groups, as all study participants reported white race/ethnicity
.
In addition, there were not enough women in the sample to analyze whether the association between elevated standing blood pressure and adverse cardiac events differed between men and women
.
Because of the relatively low number of major adverse cardiac events in this sample of young adults, this result needs to be confirmed in a larger study
.
Journal Reference :
Paolo Palatini, Lucio Mos, Francesca Saladini, Marcello Rattazzi.
Blood Pressure Hyperreactivity to Standing: a Predictor of Adverse Outcome in Young Hypertensive Patients .
Hypertension , 2022; DOI: 10.
1161/HYPERTENSIONAHA.
121.
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