Orthostatic hypotension is associated with nocturnal change in systolic blood pressure
Abstract
BACKGROUND: The circadian pattern of blood pressure (BP) has yet to be defined among individuals with orthostatic hypotension (OH). The objective of this study was to evaluate whether OH is associated with nocturnal change in systolic BP. METHODS: In a prospective study, we evaluated patients who were referred for 24-h ambulatory blood pressure monitoring (ABPM). All subjects underwent orthostatic BP testing before recording their respective 24-h ABPM. RESULTS: The study includes 185 subjects, 114 males, mean age 58 ± 18 years (range 19-89). Participants were classified, based on pattern of systolic BP changes at night, as dippers (greater than 10% decrease; n = 74), nondippers (0-10% decrease; n = 77), and reverse-dippers (increase; n = 34). Nineteen patients (10.3%) had OH. Almost all participants with OH (95%) had an abnormal diurnal BP pattern, and most of them (58%) were reverse-dippers, whereas only 56% of the participants without OH had an abnormal diurnal BP variation, and only 14% were reverse-dippers (P < 0.001). Systolic BP decreased with upright posture by 12 and 2 mm Hg in the reverse-dippers and the nondippers, respectively, and increased by 2 mm Hg in the dippers (P < 0.001). Postural changes in systolic BP were inversely related to the changes between day and night BP readings(r = -0.43; P < 0.01). In a multivariate linear regression analysis, orthostatic BP change, use of ≥2 antihypertensive drugs and female sex were related to nocturnal BP changes. CONCLUSIONS: The decrease in BP during upright posture may be a marker of nondipping or reverse-dipping pattern of diurnal BP.
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OH is frequently associated with a nocturnal 'non-dipping' or even 'reverse-dipping' BP pattern in patients with autonomic failure, with relevant therapeutic and prognostic implications.
“There is strong evidence that OH is frequently associated with a nocturnal 'non-dipping' or even 'reverse-dipping' BP pattern in patients with autonomic failure, with relevant therapeutic and prognostic implications 140,148-151”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [150]
The original contributions section says many patients with autonomic failure have both OH and a nondipping pattern, and the discussion reports an association of OH with nondipping or reverse-dipping in the study population. But the study did not establish that association specifically for reverse-dipping in patients with autonomic failure. The discussion treats prognosis as an inference it could not directly assess, and discusses treatment timing as a possible confounder rather than establishing therapeutic implications (page numbers unavailable). (LLM, conf=0.84)
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- Authors
- Voichanski, S., Grossman, C., Leibowitz, A., Peleg, E., Koren-Morag, N., Sharabi, Y., Shamiss, A., & Grossman, E.
- Affiliations
- Sheba Medical Center (IL)
- Meir Medical Center (IL)
- Corresponding author
- Grossman, E.
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-02-01
- Volume
- 25
- Issue
- 2
- Pages
- 159-164
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- OpenAlex
- W2148692074
- Cited by
- 49
- References
- 29
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 6 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 8 · 2018: 5 · 2017: 2 · 2016: 2 · 2015: 4 · 2014: 4 · 2013: 3 · 2012: 2
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- orthostatic hypotension, nocturnal blood pressure dipping, diurnal blood pressure variation, systolic blood pressure, postural blood pressure changes, ambulatory blood pressure monitoring, antihypertensive drugs, sex differences
- MeSH terms
- Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Circadian Rhythm, Drug Therapy, Combination, Female, Humans, Hypotension, Orthostatic, Male, Middle Aged, Prospective Studies, Sex Factors, Blood Pressure Monitoring, Ambulatory, Young Adult
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