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J Am Coll Cardiol, 2002; 40:133-141
© 2002 by the American College of Cardiology Foundation
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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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