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Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality
Jordan K Kondo1, William B Earle2, Ruth-Alma N Turkson-Ocran1,2
1Harvard Medical School, Boston, Massachusetts, USA.
Insights
Low standing systolic blood pressure (SBP) is common and not linked to falls or syncope. However, it is associated with reduced risk of coronary heart disease (CHD) and mortality in adults.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Current ACC/AHA guidelines recommend caution with antihypertensive therapy for low standing systolic blood pressure (SBP) <110 mm Hg due to uncertain benefits.
- Low SBP is a common finding in clinical practice, prompting investigation into its clinical significance.
Purpose of the Study:
- To investigate the association between low standing SBP (<110 mm Hg) and the risk of adverse outcomes.
- To evaluate the relationship between low standing SBP and falls, syncope, coronary heart disease (CHD), and mortality.
Main Methods:
- Utilized data from the Atherosclerosis Risk in Communities (ARIC) Study, measuring SBP in adults aged 45-64 years (1987-1989).
- Employed Cox regression to analyze associations between low standing SBP and outcomes, with follow-up through December 31, 2019.
- Ascertained falls and syncope via claims data; adjudicated CHD events. Analyzed associations across various demographic and clinical strata.
Main Results:
- Among 12,467 participants, 24% had standing SBP <110 mm Hg.
- Low standing SBP was not significantly associated with increased risk of falls or syncope (HRs 1.02, 1.02).
- Low standing SBP was associated with a significantly lower risk of CHD events (HR 0.88) and mortality (HR 0.91).
Conclusions:
- Low standing SBP is prevalent in the community and not a significant risk factor for falls or syncope.
- Low standing SBP is associated with reduced risk of coronary heart disease and mortality.
- Findings do not support screening for low standing blood pressure as a predictor of adverse events.
Background:
ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits.
Methods:
The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45-64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex.
Results:
Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex.
Conclusions:
In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.
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