Abstract
Orthostatic blood pressure (BP) dysregulation is a risk factor for both falls and cardiovascular events. Selfmeasured BP, carried out at home, is both highly reproducible and useful for evaluating antihypertensive treatment. However, there have been a few reports on the clinical implications of orthostatic BP changes in home BP monitoring (HBPM). In the baseline examination for the Japan Morning Surge-1 Study, a multicenter randomized control trial, we evaluated 605 hypertensive outpatients who had a morning systolic BP above 135 mmHg. The plasma brain natriuretic peptide (BNP) level and urinary albumin excretion were measured. When the patients were divided into 10 groups, according to orthostatic BP change evaluated by HBPM, after adjusting for age, gender, body mass index and sitting home BP level, those in the top decile (n=60, orthostatic BP increase >7.8 mmHg) had a higher urinary albumin/creatinine ratio (UAR) than the lowest decile group (geometric mean [SEM range]: 209.1 [134.7–318.7] vs. 34.1 [20.1–56.2] mg/g creatinine [Cr], p=0.003) and the pooled second to ninth decile groups (n=485, 209.1 [134.7–318.7] vs. 39.7 [33.2–47.3] mg/g Cr, p<0.02). Additionally, patients in the top decile had a higher BNP level than the second to ninth decile groups (75.7 [55.0–103.1] vs. 23.6 [20.8–26.6] pg/mL, p=0.003). Evaluation of orthostatic hypertension at home might be a high-risk factor for cardiovascular events in hypertensive subjects with increased levels of BNP and a higher UAR, independent of the home sitting BP level.
Similar content being viewed by others
Article PDF
References
Lipsitz LA : Orthostatic hypotension in the elderly. N Engl J Med 1989; 321: 952–957.
Masaki KH, Schatz IJ, Burchfiel CM, et al: Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation 1998; 98: 2290–2295.
Rose KM, Tyloler HA, Nardo CJ, et al: Orthostatic hypotension and the incidence of coronary heart disease: the Atherosclerosis Risk in Communities Study. Am J Hypertens 2000; 13: 571–578.
Nardo CJ, Chambless LE, Light KC, et al: Descriptive epidemiology of blood pressure response to change in body position. The aric study. Hypertension 1999; 33: 1123–1129.
Eigenbrodt ML, Rose KM, Couper DJ, Arnett DK, Smith R, Jones D : Orthostatic hypotension as a risk factor for stroke: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1996. Stroke 2000; 31: 2307–2313.
Streeten DH, Auchincloss JH Jr, Anderson GH Jr, Richardson RL, Thomas FD, Miller JW : Orthostatic hypertension. Pathogenetic studies. Hypertension 1985; 7: 196–203.
Sparrow D, Tifft CP, Rosner B, Weiss ST : Postural changes in diastolic blood pressure and the risk of myocardial infarction: the normative aging study. Circulation 1984; 70: 533–537.
Matsubayashi K, Okumiya K, Wada T, et al: Postural dysregulation in systolic blood pressure is associated with worsened scoring on neurobehavioral function tests and leu–koaraiosis in the older elderly living in a community. Stroke 1997; 28: 2169–2173.
Kario K, Eguchi K, Hoshide S, et al: U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor. J Am Coll Cardiol 2002; 40: 133–141.
Eguchi K, Kario K, Hoshide S, et al: Greater change of orthostatic blood pressure is related to silent cerebral infarct and cardiac overload in hypertensive subjects. Hypertens Res 2004; 27: 235–241.
Patel A, Maloney A, Damato AN : On the frequency and reproducibility of orthostatic blood pressure changes in healthy community-dwelling elderly during 60-degree head-up tilt. Am Heart J 1993; 126: 184–188.
Ward C, Kenny RA : Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med 1996; 100: 418–422.
de Buitleir M, Grogan EW Jr, Picone MF, Casteen JA : Immediate reproducibility of the tilt-table test in adults with unexplained syncope. Am J Cardiol 1993; 71: 304–307.
Bobrie G, Chatellier G, Genes N, et al: Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004; 291: 1342–1349.
Little P, Barnett J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D : Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure. BMJ 2002; 325: 254.
Imai Y, Otsuka K, Kawano Y, et al: Japanese society of hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003; 26: 771–782.
Mogensen CE : Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310: 356–360.
Yudkin JS, Forrest RD, Jackson CA : Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington diabetes survey. Lancet 1988; 2: 530–533.
Nishikimi T, Yoshihara F, Morimoto A, et al: Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension. Hypertension 1996; 28: 22–30.
de Lemos JA, McGuire DK, Drazner MH : B-type natriuretic peptide in cardiovascular disease. Lancet 2003; 362: 316–322.
Ishikawa J, Hoshide S, Shibasaki S, et al: The Japan Morning Surge-1 (JMS-1) Study: protocol description. Hypertens Res 2006; 29: 153–159.
Anwar YA, Giacco S, McCabe EJ, Tendler BE, White WB : Evaluation of the efficacy of the Omron HEM-737 IntelliSense device for use on adults according to the recommendations of the Association for the Advancement of Medical Instrumentation. Blood Press Monit 1998; 3: 261–265.
Landis JR, Koch GG : The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.
Arnlöv J, Evans JC, Meigs JB, et al: Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005; 112: 969–975.
Natale A, Akhtar M, Jazayeri M, et al: Provocation of hypotension during head-up tilt testing in subjects with no history of syncope or presyncope. Circulation 1995; 92: 54–58.
Ammirati F, Colivicchi F, Biffi A, Magris B, Pandozi C, Santini M : Head-up tilt testing potentiated with low-dose sublingual isosorbide dinitrate: a simplified time-saving approach for the evaluation of unexplained syncope. Am Heart J 1998; 135: 671–676.
Mancia G, Bertinieri G, Grassi G, et al: Effects of blood–pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet 1983; 2 ( 8352): 695–698.
Asayama K, Ohkubo T, Kikuya M, et al: Prediction of stroke by self-measurement of blood pressure at home versus casual screening blood pressure measurement in relation to the joint national committee 7 classification: the Ohasama study. Stroke 2004; 35: 2356–2361.
Hoshide S, Kario K, Eguchi K, Ishikawa J, Morinari M, Shimada K : Altered aortic properties in elderly orthostatic hypertension. Hypertens Res 2005; 28: 15–19.
Dawson A, Davies JI, Morris AD, Struthers AD : B-type natriuretic peptide is associated with both augmentation index and left ventricular mass in diabetic patients without heart failure. Am J Hypertens 2005; 18: 1586–1591.
Neumann J, Ligtenberg G, Klein II, Koomans HA, Blankestijn PJ : Sympathetic hyperactivity in chronic kidney disease: pathogenesis, clinical relevance, and treatment. Kidney Int 2004; 65: 1568–1576.
Fessel J, Robertson D : Orthostatic hypertension: when pressor reflexes overcompensate. Nat Clin Pract Nephrol 2006; 2: 424–431.
Kario K, Eguchi K, Nakagawa Y, Motai K, Shimada K : Relationship between extreme dippers and orthostatic hypertension in elderly hypertensive patients. Hypertension 1998; 31: 77–82.
Yoshinari M, Wakisaka M, Nakamura U, Yoshioka M, Uchizono Y, Iwase M : Orthostatic hypertension in patients with type 2 diabetes. Diabetes Care 2001; 24: 1783–1786.
Kario K, Ishikawa J, Pickering TG, et al: Morning hypertension: the strongest independent risk factor for stroke in elderly hypertensive patients. Hypertens Res 2006; 29: 581–587.
Author information
Authors and Affiliations
Consortia
Corresponding author
Rights and permissions
About this article
Cite this article
Hoshide, S., Matsui, Y., Shibasaki, S. et al. Orthostatic Hypertension Detected by Self-Measured Home Blood Pressure Monitoring: A New Cardiovascular Risk Factor for Elderly Hypertensives. Hypertens Res 31, 1509–1516 (2008). https://doi.org/10.1291/hypres.31.1509
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.31.1509
Keywords
This article is cited by
-
Exaggerated blood pressure response to standing in young-to-middle-age subjects: prevalence and factors involved
Clinical Autonomic Research (2023)
-
Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke
BMC Cardiovascular Disorders (2022)
-
Sitting-induced hemodynamic changes and association with sitting intolerance in children and adolescents: a cross-sectional study
Scientific Reports (2020)
-
Orthostatic hypotension and orthostatic hypertension in American veterans
Clinical Autonomic Research (2016)
-
Orthostatic hypertension—a new haemodynamic cardiovascular risk factor
Nature Reviews Nephrology (2013)