U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives
Orthostatic hypertension as a new cardiovascular risk factor
Kazuomi Kario, MD, PhD, FACC*,*,
Kazuo Eguchi, MD*,
Satoshi Hoshide, MD*,
Yoko Hoshide, MD*,
Yuji Umeda, MD*,
Takeshi Mitsuhashi, MD, PhD* and
Kazuyuki Shimada, MD, PhD*
* Department of Cardiology, Jichi Medical School, Tochigi, Japan
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Figure 1 U-curve relationship between orthostatic blood pressure (BP) change and silent cerebral infarcts in elderly subjects with sustained hypertension. The odds ratios (mean and 95% confidence interval [CI]) for silent cerebral infarcts: (A: 0 = subjects with no infarct; 1 = subjects with one or more infarcts) or for silent multiple cerebral infarcts (B: 0 = subjects with fewer than 3 infarcts; 1 = subjects with three or more infarcts) were adjusted for age (years), gender (0 = female, 1 = male), body mass index (kg/m2), smoking status (0 = nonsmoker, 1 = current smoker), presence/absence of hyperlipidemia (0 = none, 1 = present), and 24-h systolic BP (mm Hg) using multiple logistic regression analysis (Q3 = the reference group).
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Figure 2 Effect of alpha-adrenergic blocking on orthostatic blood pressure change. The dotted bars show the supine blood pressure (upper edge = systolic blood pressure; lower edge = diastolic blood pressure) and the solid bars show the orthostatic blood pressure during tilting test. The values within the arrows show the orthostatic blood pressure change (systolic/diastolic) by tilting test. The baseline orthostatic blood pressure increase was significantly higher in the orthostatic hypertension group than in the normal group (systolic blood pressure/diastolic blood pressure: 24/8.6 mm Hg vs. 1.5/2.5 mm Hg, both p < 0.01).
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