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Sex differences in the association between positional blood pressure and mortality
Savannah K Collier1, Michelle Hadad1, Bailey C Godwin2
1DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville.
Journal of Hypertension
|May 20, 2026
Summary
Blood pressure changes when moving from lying down to standing may predict mortality risk differently in men and women. Specifically, the change in supine-to-standing systolic blood pressure is a significant predictor of all-cause mortality in females.
Area of Science:
- Cardiovascular Physiology
- Gerontology
- Public Health
Background:
- Sex-based differences in mortality risk are significant.
- Incorporating body position and positional blood pressure (BP) changes may enhance the clinical utility of mortality risk prediction.
- Previous research has not fully explored the sex-specific predictive value of positional BP for all-cause mortality.
Purpose of the Study:
- To investigate the sex-dependent predictive value of supine BP, standing BP, and the change in BP from supine to standing for all-cause mortality.
- To determine if these positional BP measures offer independent predictive insights beyond traditional risk factors.
Main Methods:
- Analysis of data from 2121 apparently healthy adults (51% males, 49% females) in the Ball State Adult Fitness Longitudinal Lifestyle Study cohort.
- Measurement of resting supine and standing BP, and calculation of the supine-to-standing BP change.
- Application of Kaplan-Meier survival curves and Cox proportional hazard models, adjusting for traditional risk factors and hypertension medications.
Main Results:
- Supine and standing systolic BP (SBP) and pulse pressure (PP), along with supine diastolic BP (DBP) in females, were associated with mortality in unadjusted models.
- The change in supine-to-standing SBP predicted mortality in females, but not males, in fully adjusted models.
- The change in supine-to-standing DBP predicted mortality in males in unadjusted models, but not females.
Conclusions:
- The change in supine-to-standing SBP is an independent predictor of all-cause mortality in apparently healthy females.
- Sex-specific differences in positional BP responses may offer valuable additional diagnostic information for assessing all-cause mortality risk.
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01:28Special considerations while measuring blood pressure
When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:17Measurement of Blood Pressure
Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a stethoscope.
01:28Factors affecting Blood pressure
Several physiological and lifestyle factors influence blood pressure (BP). Understanding these factors is crucial as they are significant in patient education and blood pressure management.
Physiological Factors:
Physiological Factors:
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.
01:24Blood Pressure
The movement of blood in a human body, commonly referred to as blood flow, is determined by the volume of blood that traverses a certain section of the bodily system per unit time. It is the rhythmic contraction of the heart's ventricles that primarily instigates this movement. As the ventricles contract, blood is forced into the prominent arteries, which then flow from areas of greater pressure to lower pressure areas. This movement continues into smaller arteries and arterioles and...
01:30Blood Pressure
Blood pressure (BP) is the pressure or force of blood exerted on the artery's walls as it circulates through the body. It is essential for maintaining blood flow throughout the body.
The average BP in an adult is typically around 120/80 mmHg (millimeters of mercury). In this measurement, the numerator (120) indicates the systolic pressure, which is the pressure in the arteries during the contraction of the heart's ventricles as blood is expelled. The denominator (80) represents the diastolic...
The average BP in an adult is typically around 120/80 mmHg (millimeters of mercury). In this measurement, the numerator (120) indicates the systolic pressure, which is the pressure in the arteries during the contraction of the heart's ventricles as blood is expelled. The denominator (80) represents the diastolic...