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J Am Soc Hypertens. 2016 Nov;10(11):847-856. doi: 10.1016/j.jash.2016.08.005. Epub 2016 Aug 26.

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline.

Author information

1
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: townsend@upenn.edu.
2
Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
3
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
4
Preventive Medicine Section and Medical Service, Veterans Affairs Medical Center, Memphis, TN, USA.
5
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
6
Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
7
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA.
8
James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL, USA.
9
Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA.
10
Division of Internal Medicine, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
11
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
12
Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA.
13
Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
14
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
15
Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Abstract

Orthostatic changes in systolic blood pressure (SBP) impact cardiovascular outcomes. In this study, we aimed to determine the pattern of orthostatic systolic pressure changes in participants enrolled in the SBP Intervention Trial (SPRINT) at their baseline visit before randomization and sought to understand clinical factors predictive of these changes. Of the 9323 participants enrolled in SPRINT, 8662 had complete data for these analyses. The SBP after 1 minute of standing was subtracted from the mean value of the three preceding seated SBP values. At the baseline visit, medical history, medications, anthropometric measures, and standard laboratory testing were undertaken. The mean age of SPRINT participants was 68 years, two-thirds were male, with 30% black, 11% Hispanic, and 55% Caucasian. The spectrum of SBP changes on standing demonstrated that increases in SBP were as common as declines, and about 5% of participants had an increase, and 5% had a decrease of >20 mm Hg in SBP upon standing. Female sex, taller height, more advanced kidney disease, current smoking, and several drug classes were associated with larger declines in BP upon standing, while black race, higher blood levels of glucose and sodium, and heavier weight were associated with more positive values of the change in BP upon standing. Our cross-sectional results show a significant spectrum of orthostatic SBP changes, reflecting known (eg, age) and less well-known (eg, kidney function) relationships that may be important considerations in determining the optimal target blood pressure in long-term outcomes of older hypertensive patients.

KEYWORDS:

Cross-sectional; SBP; epidemiology; human; orthostasis

PMID:
27665708
PMCID:
PMC5344034
DOI:
10.1016/j.jash.2016.08.005
[Indexed for MEDLINE]
Free PMC Article

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