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Ghazi L, Drawz PE, Pajewski NM, et al. The Association of Orthostatic Hypotension With Ambulatory Blood Pressure Phenotypes in SPRINT. Am J Hypertens. 2021;34(5):511-520doi: 10.1093/ajh/hpaa184.
Ghazi, L., Drawz, P. E., Pajewski, N. M., & Juraschek, S. P. (2021). The Association of Orthostatic Hypotension With Ambulatory Blood Pressure Phenotypes in SPRINT. American journal of hypertension, 34(5), 511-520. https://doi.org/10.1093/ajh/hpaa184
Ghazi, Lama, et al. "The Association of Orthostatic Hypotension With Ambulatory Blood Pressure Phenotypes in SPRINT." American journal of hypertension vol. 34,5 (2021): 511-520. doi: https://doi.org/10.1093/ajh/hpaa184
Ghazi L, Drawz PE, Pajewski NM, Juraschek SP. The Association of Orthostatic Hypotension With Ambulatory Blood Pressure Phenotypes in SPRINT. Am J Hypertens. 2021 May 22;34(5):511-520. doi: 10.1093/ajh/hpaa184. PMID: 33186448; PMCID: PMC8140655.
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Am J Hypertens. 2021 May 22;34(5):511-520. doi: 10.1093/ajh/hpaa184.

The Association of Orthostatic Hypotension With Ambulatory Blood Pressure Phenotypes in SPRINT.

American journal of hypertension

Lama Ghazi, Paul E Drawz, Nicholas M Pajewski, Stephen P Juraschek

Affiliations

  1. Yale University, School of Medicine, Clinical and Translational Research Accelerator, New Haven, Connecticut, USA.
  2. University of Minnesota Medical School, Department of Medicine, Division of Nephrology and Hypertension, Minneapolis, Minnesota, USA.
  3. Wake Forest School of Medicine, Department of Biostatistics and Data Science, Winston-Salem, North Carolina, USA.
  4. Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Medicine, Division of General Medicine, Boston, Massachusetts, USA.

PMID: 33186448 PMCID: PMC8140655 DOI: 10.1093/ajh/hpaa184

Abstract

BACKGROUND: Clinic blood pressure (BP) when measured in the seated position, can miss meaningful BP phenotypes, including low ambulatory BP (white coat effects [WCE]) or high supine BP (nocturnal non-dipping). Orthostatic hypotension (OH) measured using both seated (or supine) and standing BP, could identify phenotypes poorly captured by seated clinic BP alone.

METHODS: We examined the association of OH with WCE and night-to-daytime systolic BP (SBP) in a subpopulation of SPRINT, a randomized trial testing the effects of intensive or standard (<120 vs. <140 mm Hg) SBP treatment strategies in adults at increased risk of cardiovascular disease. OH was assessed during follow-up (6, 12, and 24 months) and defined as a decrease in mean seated SBP ≥20 or diastolic BP ≥10 mm Hg after 1 min of standing. WCE, based on 24-hour ambulatory BP monitoring performed at 27 months, was defined as the difference between 27-month seated clinic and daytime ambulatory BP ≥20/≥10 mm Hg. Reverse dipping was defined as a ratio of night-to-daytime SBP >1.

RESULTS: Of 897 adults (mean age 71.5±9.5 years, 29% female, 28% black), 128 had OH at least once. Among those with OH, 15% had WCE (vs. 7% without OH). Moreover, 25% of those with OH demonstrated a non-dipping pattern (vs. 14% without OH). OH was positively associated with both WCE (OR=2.24; 95%CI: 1.28, 4.27) and reverse dipping (OR=2.29; 95% CI: 1.31, 3.99).

CONCLUSIONS: The identification of OH in clinic was associated with two BP phenotypes often missed with traditional seated BP assessments. Further studies on mechanisms of these relationships are needed.

CLINICAL TRIALS REGISTRATION: Trial Number NCT03569020.

© American Journal of Hypertension, Ltd 2020. All rights reserved. For Permissions, please email: [email protected].

Keywords: ambulatory blood pressure monitoring; blood pressure; hypertension; nocturnal dipping status; orthostatic hypotension; white coat effects

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