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Published on: March 21, 2013
Associations of Hypertension and Orthostatic Hypotension With Subclinical Cardiovascular Disease
Aldis H Petriceks1,2, Lawrence J Appel3,4, Edgar R Miller3,4
1Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Insights
Hypertension, not hypotension, is linked to higher cardiac biomarkers in older adults. This suggests high blood pressure, not low blood pressure, may drive subclinical cardiac injury in this population.
Area of Science:
- Cardiology
- Gerontology
- Hypertension Research
Background:
- Orthostatic hypotension is a known risk factor for cardiovascular disease.
- The specific blood pressure phenotype (high seated vs. low standing) contributing to this association remains unclear.
- This study investigates the relationship between orthostatic hypotension and hypertension with cardiac injury biomarkers.
Purpose of the Study:
- To compare the associations of orthostatic hypotension and hypertension with cardiac injury biomarkers.
- To determine if high seated blood pressure or low standing blood pressure is more strongly associated with cardiovascular disease.
- To elucidate the mechanisms underlying subclinical cardiac injury in older adults.
Main Methods:
- Secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (a randomized controlled trial).
- Inclusion of community-dwelling adults aged 70 years and older.
- Measurement of high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide alongside blood pressure readings.
Main Results:
- Seated hypertension was associated with significantly higher levels of both high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide.
- Standing hypertension also showed a significant association with increased levels of both cardiac biomarkers.
- No significant associations were found between hypotensive phenotypes and the measured cardiac biomarkers.
Conclusions:
- Both seated and standing hypertension are linked to elevated cardiac injury biomarkers in older adults.
- Hypotensive phenotypes, including orthostatic hypotension, were not associated with these biomarkers.
- Subclinical cardiac injury in older adults with orthostatic hypotension may not be primarily driven by hypoperfusion.
Background:
Orthostatic hypotension is associated with cardiovascular disease. It remains unclear if low standing blood pressure or high seated blood pressure is responsible for this association. We compared associations of orthostatic hypotension and hypertension with high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide.
Methods:
We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You, a randomized controlled trial funded by the National Institute on Aging, between July 2015 and May 2019. Participants were community-dwelling adults, 70 years or older. Blood tests for high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide were drawn at visits concurrent with blood pressure measurements. Secondary analysis occurred in 2023. We determined associations between blood pressure phenotypes and cardiac biomarkers.
Results:
Of 674 participants (mean age 76.5 ± 5.4 years, 43% female, 17.2% Black race), 29.1% had prior cardiovascular disease. Participants with seated hypertension had 10.1% greater high-sensitivity cardiac troponin I (95% confidence interval = 3.8-16.9) and 11.0% greater N-terminal pro-B-type natriuretic peptide (4.0-18.6) than those without seated hypertension. Participants with standing hypertension had 8.6% (2.7-14.9) greater high-sensitivity cardiac troponin I and 11.8% greater N-terminal pro-B-type natriuretic peptide (5.1-18.9) than those without standing hypertension. Hypotensive phenotypes were not associated with either biomarker.
Conclusions:
Both seated and standing hypertension were associated with greater high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide, but hypotensive phenotypes were not. Hypoperfusion may not be the principal mechanism behind subclinical cardiac injury among older adults with orthostatic hypotension.
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