Orthostatic changes in systolic blood pressure among SPRINT participants at baseline.
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.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: townsend@upenn.edu.
Raymond R
RR
Townsend
Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
Tara I
TI
Chang
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Debbie L
DL
Cohen
Preventive Medicine Section and Medical Service, Veterans Affairs Medical Center, Memphis, TN, USA.
William C
WC
Cushman
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Gregory W
GW
Evans
Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Stephen P
SP
Glasser
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA.
William E
WE
Haley
James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL, USA.
Christine
C
Olney
Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA.
Suzanne
S
Oparil
Division of Internal Medicine, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Rita
R
Del Pinto
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Roberto
R
Pisoni
Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA.
Addison A
AA
Taylor
Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
Kausik
K
Umanath
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Jackson T
JT
Wright
Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Joseph
J
Yeboah
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D001827:Body Height; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007024:Hypotension, Orthostatic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D012737:Sex Factors; D013599:Systole
D000959:Antihypertensive Agents
Cross-sectional; SBP; epidemiology; human; orthostasis
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