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Preliminary research suggests that measuring a patient’s blood pressure (BP) while they are lying down may provide more comprehensive information about their cardiovascular risk compared to taking the reading while the patient is seated upright.
An examination of data from the extensive Atherosclerosis Risk in Communities (ARIC) study, which involved over 11,000 adults, revealed that individuals with hypertension while lying down were at a heightened risk for cardiovascular disease (CVD) regardless of whether they also had hypertension while sitting.
Lead investigator Duc M. Giao, a researcher and fourth-year MD student at Harvard Medical School, Boston, emphasized the importance of including supine BP measurements alongside seated ones. Giao presented these findings at the Hypertension Scientific Sessions (HYP) 2023 in Boston, Massachusetts.
Although hypertension during sleep has a strong correlation with CVD and mortality, it remained uncertain whether hypertension detected while a patient is lying flat in a clinical setting is an independent risk factor for CVD when compared to the patient’s BP while seated.
To delve into this, Giao and his team analyzed health data from 11,369 adults participating in the ARIC study, with an average age of 54 years. Of these, 56% were women, and 25% were Black individuals. None of them had a history of coronary heart disease (CHD), heart failure (HF), or stroke at the beginning of the study.
As part of the study, both supine and seated BP measurements were recorded during the initial ARIC visit between 1987 and 1989. Both seated and supine hypertension were defined as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg.
The data showed that 16% of those without seated hypertension had supine hypertension, while 74% of those with seated hypertension also had supine hypertension.
Even after accounting for seated hypertension, during a median follow-up period of 25 to 28 years, supine hypertension was associated with an increased risk of incident CHD, HF, stroke, fatal CHD, and all-cause mortality. This association was consistent regardless of antihypertensive medication use.
For patients with hypertension while lying down but not while seated, the risk elevation was similar to those who had hypertension in both positions.
Giao recommended that individuals with known risk factors for heart disease and stroke may benefit from having their blood pressure checked while lying flat. He also suggested that efforts to manage blood pressure during daily activities might help lower blood pressure during sleep. He proposed that future research should compare supine blood pressure measurements in the clinic with overnight measurements.
Commenting on the study, Wanpen Vongpatanasin, MD, clinical chair for the conference, emphasized the importance of maintaining blood pressure control in all body positions. She noted that various population-based studies have demonstrated that nighttime BP independently predicts cardiovascular outcomes. Vongpatanasin pointed out that it is unclear whether the timing or position of BP measurement (night vs. day, supine vs. upright) explains this phenomenon.
The study led by Giao and his colleagues suggests that supine BP may be a contributing factor, given its comparable impact on long-term cardiovascular outcomes as seated BP. However, in busy clinical practice, conducting both seated and supine BP measurements, along with standing BP, can be challenging. Vongpatanasin concluded that further research is needed to determine what constitutes a normal supine BP and how to integrate it into hypertension management.
