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Orthostatic hypertension. Pathogenetic studies.

D H Streeten, J H Auchincloss, G H Anderson

    Hypertension (Dallas, Tex. : 1979)
    |March 1, 1985
    PubMed
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    Orthostatic hypertension, characterized by elevated standing diastolic blood pressure, is common. It stems from excessive blood pooling in the legs upon standing, leading to reduced cardiac output and increased sympathetic activity.

    Area of Science:

    • Cardiovascular Physiology
    • Hypertension Research
    • Autonomic Nervous System Function

    Background:

    • Orthostatic hypotension is a recognized condition, but orthostatic hypertension is less understood.
    • Identifying mechanisms of orthostatic hypertension is crucial for managing hypertensive patients.

    Purpose of the Study:

    • To investigate the prevalence and underlying mechanisms of orthostatic hypertension.
    • To compare physiological responses between orthostatic hypertensive and normotensive individuals.

    Main Methods:

    • Recumbent and standing blood pressure measurements in 1800 hypertensive patients.
    • Cardiac output, blood pooling (using gamma counting), and plasma norepinephrine levels were assessed.
    • Intervention with an inflatable pressure suit to evaluate its effect on orthostatic responses.

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    Main Results:

    • 181 patients (10%) exhibited orthostatic hypertension (recumbent DBP <90 mmHg, standing DBP >90 mmHg).
    • Orthostatic hypertensive patients showed a greater fall in cardiac output and significantly more lower-body blood pooling compared to normotensive subjects.
    • Plasma norepinephrine levels increased significantly after standing in orthostatic hypertensive patients.

    Conclusions:

    • Orthostatic hypertension is a prevalent condition in referred hypertensive patients.
    • The mechanism involves excessive gravitational pooling of blood in the lower extremities upon standing.
    • This pooling leads to decreased venous return, reduced cardiac output, and compensatory sympathetic activation causing arteriolar constriction.