Day-to-Day Home Blood Pressure Variability and Orthostatic Hypotension: The Nagahama Study. (19th September 2018)

• Record Type: Journal Article
• Authors: Tabara, Yasuharu; Matsumoto, Takeshi; Murase, Kimihiko; Setoh, Kazuya; Kawaguchi, Takahisa; Nagashima, Shunsuke; Kosugi, Shinji; Nakayama, Takeo; Wakamura, Tomoko; Hirai, Toyohiro; Chin, Kazuo; Matsuda, Fumihiko
• Is Part Of: American journal of hypertension. Volume 31:Number 12(2018:Dec.)
• Page Start: 1278
• Page End: 1285
• Publication Date: 2018-09-19
• Subjects: blood pressure -- blood pressure variability -- general population; home blood pressure -- hypertension -- orthostatic hypotension; Hypertension -- Periodicals; 616.132005
• DOI: 10.1093/ajh/hpy131
• Languages: English
• ISSNs: 0895-7061

Abstract

Abstract: BACKGROUND: The aim of this study is to clarify associations between orthostatic blood pressure (BP) change, as well as possible physiological factors, and day-to-day home BP variability, a promising risk factor for cardiovascular outcomes. METHODS: Study participants were 6, 465 community residents (age 58.3 years). Home BP was measured every morning and evening for 7 days. Orthostatic BP was calculated as the maximum difference between BP measured while sitting and remeasured after 1 and 3 minutes standing. RESULTS: Frequency of individuals who showed orthostatic BP decline was as follows: systolic BP (SBP) change ≥−20 mm Hg: 2.6%, ≥−10 mm Hg: 14.1%. These subgroups showed larger home SBP variability (average real variability: 11.3 ± 5.3, 8.7 ± 3.9 mm Hg) when compared with orthostatic normotensives (7.6 ± 3.7 mm Hg) (all P < 0.001). Multiple linear regression analysis adjusted for major covariates, including seated BP, identified orthostatic BP drop as an independent determinant for morning BP variability (≥−20 mm Hg: β = 0.037, P = 0.003; ≥−10 mm Hg: β = 0.026, P = 0.036) but not for evening BP variability. Carotid hypertrophy was significantly associated with home BP variability (morning: β = 0.052, P = 0.001; evening: β = 0.065, P < 0.001) and showed a U-shaped association with orthostatic BP change. Plasma B-type natriuretic peptide level, a previously suggested factor for BP variability, did not show significant association with morning and evening BP variability. CONCLUSION: Orthostatic BP decline was significantly associated with morning BP variability. Large artery atherosclerosis was a common risk factor.