Orthostatic blood pressure transitions: Association with symptoms and frailty

Individuals with hypertension may transition between different orthostatic blood pressure (BP) phenotypes within minutes. We studied the temporal patterns of orthostatic BP responses and their relationship to symptom development in older hypertensive individuals with and without frailty.

A cross-sectional study was conducted, including patients aged at least 60 years. BP was measured seated and at 1 and 3-min post-standing. Orthostatic hypotension and orthostatic hypertension (OHT) were defined in accordance with current guidelines. Orthostatic intolerance was defined as symptoms upon standing. Frailty was assessed using the Clinical Frailty Scale. Multivariable logistic regression models evaluated associations between orthostatic BP phenotypes, orthostatic intolerance and Frailty.

We included 461 hypertensive adults (mean age: 72.5 ± 7.0 years, 70% women). The prevalence of orthostatic hypotension and OHT was 11 and 10%, respectively. About 50% of individuals with orthostatic hypotension or OHT at minute 1 normalized their BP by minute 3, while a similar absolute number with normal BP at minute 1 developed orthostatic hypotension or OHT by minute 3. Frail individuals exhibited a twofold higher prevalence of orthostatic hypotension [odds ratio (OR) 2.39, P  = 0.023], and a more than threefold higher prevalence of OHT (OR 3.60, P  < 0.001). In fully adjusted models, orthostatic intolerance was associated with both systolic orthostatic hypotension (OR 3.05, P  = 0.019) and OHT (OR 2.33, P  = 0.041).

Orthostatic BP phenotypes in hypertensive older adults were dynamic, with frequent shifts between 1 and 3 minutes of standing. Frailty and OI were strongly associated not only with OH but also with OHT.